Peroral cholangioscopy-assisted guidewire placement for removal of impacted stones in the cystic duct remnant.

It is well known that impacted biliary stones are difficult to remove endoscopically. Among the many factors associated with failure of endoscopic therapy for removal of bile duct stones, impaction ranks high. One of the reasons behind failure of endoscopic therapy in such cases is that the impacted stone often does not allow passage of a guidewire. Recent introduction of a novel single-operator cholangioscopy system has made it possible for a single endoscopist to use cholangioscopy for evaluation and treatment of a wide variety of biliary disorders. This cholangioscopy system was used for placement of a guidewire in the cystic duct remnant with subsequent removal of an impacted stone which had prevented passage of a guidewire by conventional means.