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Silent migration: unexpected finding at ERCP
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- bile duct stones
- cholecystectomy
- endoscopic balloon sphincteroplasty
- endoscopic retrograde pancreatography
- surgical complications
An elderly patient with a history of laparoscopic cholecystectomy presented with recurrent abdominal pain. Imaging revealed a dilated common bile duct (CBD) with filling defects. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated multiple linear metallic clips with a halo of calculus material (figure 1). Attempts at removing the clips following a 10 mm sphincteroplasty resulted in horizontal impaction of clips beneath the trawling balloon (figure 2), increasing the risk …