Standard endoscopic management of choledocholithiasis does not always result in complete removal of all stones from the common bile duct. This protocol addresses the specific situation where the first-line endoscopic approach falls short of that goal and a structured next step is required.
The initial approach — ERCP with endoscopic sphincterotomy at the ampulla of Vater, balloon dilatation, and stone extraction using a balloon or basket catheter, followed by laparoscopic cholecystectomy — did not achieve its primary endpoint: complete extraction of all gallstones from the common bile duct. This protocol applies when that goal is not reached.
When complete stone clearance cannot be achieved by the initial endoscopic procedure, a biliary stenting technique may be employed as a bridge intervention. The full protocol specifies the procedure, sequence, and follow-up considerations — access the complete regimen below.