To evaluate the efficacy and safety of peroral direct cholangioscopy(PDCS) in the treatment of refractory common bile duct stones after retrograde cholangiopancreatography(ERCP).

Data of 13 patients who underwent peroral direct cholangioscopy for refractory common bile duct stones after retrograde cholangiopancreatography at our institution from April 2012 to August 2014 were retrospectively analyzed. Completion rate, side–effects and complications were summarized.

Peroral direct cholangioscopy was successfully performed with electrohydraulic lithotripsy and stones were removed in 12 of the 13 patients. Lithotripsy and stone removal failed in one patient, though the ultraslim endoscope accessed distal common bile duct near the stone. Stones were removed directly with extraction basket under PDCS in 7 patients, and duodenoscopy was performed in 5 patients due to too many stone fragments. Stone removal was successfully completed at one time in 9 cases. Stones removal failed in 3 cases at one time because of too many stone fragments, but was successful with duodenoscopy a week later after a temporary biliary tract stenting. Andoxygen saturation decreased in one patient due to vomit during the operation. Sputum in oropharyngeal area was immediately sucked out and the gastric juice at the bottom of the stomach was also sucked by endoscopy. Oxygen saturation returned to normal levels and the subsequent operation was not affected. No aspiration pneumonia occurred after the operation. Hyperamylasemia occurred in two patients, and postoperative biliary tract infection occurred in one, but the situation was controlled after appropriate treatment.

PDOS using an ultraslim endoscopy is an effective and feasible endoscopic procedure for the refractory common bile duct stones. This study provides a new method for the treatment of refractory common bile duct stones.

Choledocholithiasis; Direct cholangioscopy; Ultraslim endoscopy; Cholangiopancreatography, endoscopic retrograde