Loh Wei-Liang is a Senior Resident of General Surgery in Singhealth, Singapore. He has interests in surgical oncology, endoscopy, and medical education. Outside of work, he loves to travel and experience new cultures.



Difficult and large common bile duct stones can be crushed and removed using a mechanical lithotripter. Very often the lack of working space within the common bile duct causing the failure of mechanical lithotripsy would inevitably mean repeat or further invasive procedures. We herein describe a novel and ingenious technique of utilizing a through-the –scope (TTS) dilator in helping to expand the space within the common bile duct to allow for full deployment of a mechanical lithotripter and successful clearance of common bile duct stones. This ingenious method can be easily applied by advanced endoscopists and is expected to lead to increased success rates of clearance of difficult common bile duct stones.