Resolution of ampullary stone impaction with duodenoscopy-guided direct frequency-doubled double-pulse Nd:YAG laser lithotripsy after the failure?of?rescue?lithotripsy

摘要

An 84-year-old woman received a diagnosis of largecommon bile duct (CBD) stones and experienced failedendoscopic stone extraction half a year previously.Two plastic stents were temporarily placed into theCBD for biliary drainage. Currently, the patient wasadmitted for endoscopic stone extraction. The cholangiogram demonstrated a maximal diameter of 1.5 cm ofthe CBD, with multiple large stones. The largest stone(1.4 2.5 cm) was impacted in the upper part of theCBD (Fig. 1A).