Published online Jul 16, 2021. doi: 10.4253/wjge.v13.i7.198
Peer-review started: March 21, 2021
First decision: May 4, 2021
Revised: May 18, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: July 16, 2021
Core Tip: Difficult common bile duct stone is defined based on the characteristics of the stone, accessibility to papilla related to anatomical variations, and other clinical conditions or comorbidities of the patients. Currently, endoscopic papillary large balloon dilation (EPLBD) of a previous sphincterotomy or EPLBD combined with limited sphincterotomy performed on the same session is still recommended as the main approach in difficult common bile duct stone with history of failed sphincterotomy and balloon and/or basket attempts. No significant difference has been observed in mortality and morbidity rates, as well as conversion to open surgery between groups treated with a single-stage laparoscopic procedure and two-stage endoscopic and laparoscopic procedures.