Endoscopic removal of choledocholithiasis


  • A 69 years old lady
  • History of recurrent right hypochondriac pain
  • Current presentation with slight jaundice

ERCP findings:

  • There is filling defect seen within the gall bladder suggestive of calculus (red arrow).
  • The cystic duct is dilated measuring about 9 mm (white arrow).
  • The common duct is also dilated measuring about 13 mm.
  • There are multiple filling defect at distal common duct in keeping with calculi (yellow arrows).
  • The intrahepatic ducts are not dilated.
  • The calculi within the common duct were removed during the procedure.

Diagnosis: Choledocholithiasis and cholelithiasis, endoscopic removal of choledocholithiasis.


  • Choledocholithiasis is stone within the bile ducts (including the common hepatic duct/common bile duct).
  • Choledocholithiasis is relatively common, seen in 6-12% of patients who undergo cholecystectomy.
  • Stones within the bile duct may form either in-situ or pass from the gallbladder, and when recurrent tend to be pigment stones, and are thought to be associated with bacterial infection.
  • Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the treatment of choice for choledocholithiasis.
  • This procedure is associated with a complication rate of 5.8-24%.
Author: radhianahassan