title: Successful Removal of a Large Common Bile Duct Stone by Using Direct Peroral Cholangioscopy and Laser Lithotripsy in a Patient with Severe Kyphosis.
abstract: A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Song I
authors.initials: SI
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Byung Hun
authors.initials: BH
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Won Gak
authors.initials: WG
authors.lastname: Heo
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Tae Hyeon
authors.initials: TH
authors.lastname: Kim
keywords: Cholangiography; Cholangitis; Gallstones; Kyphosis