Stone Management

Calculous disease of the biliary tract is the general term applied to diseases of the gallbladder and biliary tree that are a direct result of gallstones. Gallstone disease is the most common disorder affecting the biliary system. In the United States, approximately 10–15% of the adult population has gallstones, with approximately one million cases presenting each year. Gallstones are the most common gastrointestinal disorder requiring hospitalization. The annual cost of gallstones in the United States is estimated at 5 billion dollars¹.


Endoscopic retrograde cholangiopancreatography (ERCP) is often used for the initial treatment of most bile duct stones, with more than 1 million people worldwide undergoing ERCP procedures annually. While stones can be removed with standard ERCP techniques, approximately 10%-15% are considered difficult and cannot be treated effectively². Electrohydraulic Lithotripsy (EHL) is one option to remove difficult stones. The American Society of Gastrointestinal Endoscopy finds EHL not only to be effective, “but relatively inexpensive” compared to other modalities, such as laser lithotripsy³. The EHL probe must be passed through a cholangioscope for direct visualization and treatment enabling an increased stone clearance success rate in a single session¹.



  2. Chen YK, Parsi MA, Binmoeller KF, et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc. 2011;74(4):805-814.

  3. American Society for Gastrointestinal Endoscopy. Biliary and pancreatic lithotripsy devices, ASGE technology status evaluation report. 2007.

Gastroenterology Lithotripsy