1 | INTRODUCTION
Common bile duct (CBD) stones are, generally, a risk factor for cholangitis and therefore, should be removed. Surgical lithotomy or endoscopic lithotomy is the preferred treatment modality to treat CBD stones. Owing to its minimally invasive nature, endoscopic lithotomy has become the first choice of treatment.
CBD stones may prove challenging to remove by endoscopic lithotomy, especially in patients with a very large stone size, multiple stones packed closely,1-5 a history of digestive tract reconstruction,6,7or a combination of these factors. In addition to the above mentioned factors, the presence of a CBD stricture also increases the difficulty of endoscopic lithotomy.8-10 If a distal CBD stricture is narrower than the diameter of the CBD stones, removing the stones becomes further complicated.
Herein, we report a case in which the CBD stones were difficult to remove due to a CBD stricture caused by chronic pancreatitis (CP) and therefore; were also difficult to treat by endoscopic lithotripsy. However, these stones were spontaneously removed using a covered self-expanding metallic stent (CSEMS).