Endoscopic treatment of large cholelithiasis

Present article gives comprehensive review on problem of large cholelithiasis, unsolved questions of endoscopic treatment in gallstone disease. Main landmarks of clinical anatomy of major papilla, terminal bile duct stated, including role of intrapancreatic segment of terminal choledochus. Indications, contraindications, complications and effectiveness of mechanical lithotripsy and large balloon dilatation described, including pro and contra in large balloon dilatation without prior sphincterotomy. Different views on choice between traditional endoscopic methods in large cholelithiasis are present. Review of contemporary methods, including single operator cholangioscopy guided lithotripsy is given, abilities of cholangioscopy using ultrathin scope stated. Attention on options of endoscopic treatment depending on anatomy of terminal bile duct is paid. Authors give ideas for future research of algorithm of endoscopic treatment in patients with large cholelithiasis, basing on anatomy, fluoroscopy findings and opportunities in specific hospital.