Fig. 2.

Fifty-six year-old male complaining of fever and right upper quadrant pain.

A. Multiple filling defects are seen in Common bile duct, indicating multiple stones. Common bile duct is severely dilated, measuring 16-17 mm in diameter.

B-D. Stone evacuation with occlusion balloon failed. The occlusion balloon passed over the stone, unable to push the stones effectively.

E. Even a larger sized balloon (13 mm), that is used for endoscopic common bile duct stone removal, fails in pushing the stones.

F. Multiple stones still remain in common bile duct.