LAUSR

A 62-year-old man was admitted with epigastralgia. He had a history of laparoscopic cholecystectomy for cholecystolithiasis. He had no coagulopathy and was not taking anticoagulants. Abdominal computed tomography (CT) showed a common bile duct (CBD) stone (▶Fig. 1 a). Endoscopic retrograde cholangiography (ERC) and intraductal ultrasonography (IDUS) also showed a 2.8-mm CBD stone (▶Fig. 1b, ▶Fig. 2 a, b). Endoscopic sphincterotomy (EST) was performed (▶Fig. 2 c) and the CBD stone was removed using a wire basket (▶Fig. 2d). The patient complained of epigastralgia again after 4 days. Laboratory investigations demonstrated elevated cholestatic parameters: total bilirubin 2.8mg/dL (normal range 0.4–1.5mg/dL), aspartate aminotransferase 176U/L (13–30U/L), alanine aminotransferase 146U/L (10– 42U/L), alkaline phosphatase 233U/L (38–113U/L), and gamma-glutamyl transpeptidase 695U/L (9–32U/L); hemoglobin was within the normal limit. CT showed a diffuse high-density structure in the CBD, with the bile duct mildly dilated (▶Fig. 3 a). ERC revealed post-EST bleeding and a biliary clot in the CBD (▶Fig. 3b, ▶Fig. 4 a). The clot was removed using a grasping forceps and wire basket (▶Fig. 3 c, ▶Fig. 4b), and an endoscopic biliary stent (EBS) was inserted into the CBD for biliary drainage. Clipping was applied to stop the bleeding (▶Fig. 3d, ▶Fig. 4 c, d, ▶Video 1). The patient progressed well after the procedures. The EBS was removed 8 days postoperatively and the patient was discharged 10 days postoperatively. E-Videos