Comparing holmium laser and electrohydraulic lithotripsy for clearing difficult bile duct and pancreatic duct stones

You may qualify if

• Age 19-85 years
• Signed written informed consent.
• Presence of one or more biliary (common bile duct or intrahepatic) or pancreatic duct stones that are deemed "difficult" based on at least one of the following criteria:; Stone diameter ≥ 15 mm in any single dimension as measured on prior cross-sectional imaging (CT, MRCP, or EUS).; Presence of an impacted stone that cannot be dislodged with a standard balloon or basket.; Stone located proximal to a benign biliary or pancreatic duct stricture.; Documented failure of stone extraction during a prior ERCP attempt using standard techniques (e.g., sphincterotomy with balloon/basket extraction).

You can't join if

• Pregnancy: Repeated ERCP would be delayed until after delivery if possible
• Clinically significant, uncorrectable coagulopathy (defined as INR > 1.5 or platelet count < 50,000/μL).
• Surgically altered upper gastrointestinal anatomy that precludes conventional ERCP access (e.g., Roux-en-Y gastric bypass), unless an alternative access route (e.g., laparoscopy-assisted or EUS-directed) is planned as the standard of care.
• Known or highly suspected malignant biliary or pancreatic stricture associated with the stone.
• Acute pancreatitis at the time of screening, unless it is gallstone pancreatitis with persistent biliary obstruction, for which ERCP is therapeutically indicated.
• Severe cardiopulmonary disease or other comorbidities that, in the judgment of the investigator, would make the patient an unsuitable candidate for a prolonged endoscopic procedure under general anesthesia.
• Known life expectancy of less than 6 months.
• Inability or unwillingness to comply with study procedures or follow-up requirements.