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Hybrid lithotripsy with endoscopic ultrasound‐guided antegrade intervention and balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography for stacked bile duct stones

BALLOON ENTEROSCOPY‐ASSISTED ENDOSCOPIC retrograde cholangiopancreatography (BEERCP) and endoscopic ultrasound (EUS)-guided antegrade intervention have been reported to be useful for bile duct stones in patients with surgically altered anatomy. Regardless of the approach used, lithotripsy should be used first to crush large stones. However, lithotripsy is difficult to achieve using only one approach in patients with stacked large stones because of the limited space available to grasp them. Herein, we describe a case of stacked stones in which a hybrid approach to lithotripsy was successfully performed. An 80-year-old man who had undergone total gastrectomy with Roux-en-Y reconstruction was admitted to our hospital with acute cholangitis due to stacked stones