Figure 1.

A, Coronal section of abdominal CT image showing multiple common bile duct stones. B, Cholangiographic view with use of a short double-balloon endoscope (DBE) showing large stones in the common bile duct. C, Withdrawal of DBE while the overtube is kept in situ, and insertion of an ultraslim endoscope through the overtube. D, Fluoroscopic image of EHL under DBE-assisted direct cholangioscopy using an ultraslim upper endoscope. E, Endoscopic image of stone fragmentation by electrohydraulic lithotripsy (EHL) under DBE-assisted direct cholangioscopy by use of an ultraslim upper endoscope. Large bile duct stones were successfully fragmented by EHL. F, Balloon-occluded cholangiogram after stone removal, suggesting no residual stones in the bile duct. DBE, double-balloon endoscope; EHL, electrohydraulic lithotripsy.