Endoscopic Retrograde Cholangiopancreatography Combined With Percutaneous Transhepatic Cholangial Drainage Sinus Tract for the Treatment of Giant Common Bile Duct Stones

Giant common bile duct stones are hard to extract, with high adverse events and recurrence, and single treatments have limitations. This study explores managing them with endoscopic retrograde cholangiopancreatography (ERCP) combined with percutaneous transhepatic cholangial drainage (PTCD) sinus tract. A 66-year-old man with recurrent common bile duct stones (multiple large extrahepatic stones) complicated by cholangitis and acute liver failure was admitted. He first received PTCD with T-tube drainage, ERCP for stone extraction, and stent placement. Three months later, a 71 × 30-mm stone was found and successfully fragmented via PTCD sinus tract and 2 ERCP sessions with electrohydraulic lithotripsy, without complications. This combined technique enables minimally invasive staged drainage, lithotripsy, and stone extraction for complex giant stones, providing early drainage with minimal trauma and a new strategy for recurrent or high-risk patients.