Fig. 4. Direct peroral cholangioscopy (POC)-guided stone removal by using a multibending ultra-slim endoscope after laser lithotripsy. (A) Cholangiogram shows stones in the left intrahepatic duct (IHD) and a multibending endoscope located in IHD without device assistance. (B) Cholangioscopic view of IHD stone with laser lithotripsy probe. (C) Cholangiogram shows no filling defect in the left IHD after stone removal. (D) Cholangioscopic view of small residual stones detected by direct POC. (E, F) Cholangioscopic view shows IHD stone extraction into the duodenum using a 5-Fr basket catheter under direct endoscopic visualization.
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