This 40 year old lady had a pre ERCP ultrasound which indicated a single 9mm stone in the distal CBD. Going in, we were encountered by a swollen ampulla (A: green arrow), suggesting an impacted stone. Dye injection showed a grossly dilated CBD (B: green arrows) and negative shadows (B :red arrows). The stones could not be removed even after a wide papillotomy. So we went for a sphincteroplasty with an 18mm TTS (through the scope) wire guided balloon (C1 & C2 and D: green arrow showing the inflated balloon at the ampulla). One stone was retrieved (E: green arrow). Repeat cholangiogram showed more stones in the mid CBD (F: green arrow). The remain stones were removed with an extraction basket (G1: green arrow marks the stone and red arrow indicates the basket wires. G2: red arrow marks the stone trapped in the basket wires)
