Factors associated with difficult bile duct stone extraction during ERCP

Stone characteristics

Large size (>1 cm)

Multiple stones (>3 stones)

Location: Proximal to biliary stricture, impacted in bile duct, or intrahepatic

Anatomic factors*

Surgically altered anatomy (eg, Roux-en-Y anatomy)

Tortuous bile duct

Refer to UpToDate content on endoscopic management of bile duct stones for more detail.

ERCP: endoscopic retrograde cholangiopancreatography.

* Anatomic factors associated with difficult stone extraction may be the result of one or more technical difficulties (ie, reaching the ampulla endoscopically, difficulty cannulating the biliary tree, and/or performing sphincterotomy). Refer to UpToDate content on ERCP in patients with altered anatomy.

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Factors associated with difficult bile duct stone extraction during ERCP