Patient: Description of condition (onset, main symptoms, hospital visited, etc.): I had a cholecystectomy 10 years ago. Recently, I have been experiencing occasional abdominal pain. Laboratory and examination results: Hepatitis 7 normal, ultrasound shows multiple strong light masses in the common bile duct, MRCP shows common bile duct with obstruction and intrahepatic bile duct also has stones, the largest is 11MM, liver function 1 shows; ALT287,AST274,GGT1924,DBIL8.9,TBA61.3, other normal. Patient’s age:36 Patient’s gender:male In September 2011, he underwent an unsuccessful ERCP procedure at Zunyi Medical College Hospital in Guizhou to retrieve the stone, saying that the lower end of the common bile duct was inflamed and the cannula was unsuccessful. The hospital suggested that he be transferred to another hospital for ERCP surgery. Is your hospital able to perform this surgery? What is the best treatment plan? Is it possible to see you? Miao Lin, Second Affiliated Hospital of Nanjing Medical University, Gastroenterology Center: You can come to our hospital for ERCP surgery. We do more than 1,000 cases every year, with a success rate of more than 99%. The Second Affiliated Hospital of Nanjing Medical University Gastroenterology Center Miao Lin 13382763268 Patient: Dear Professor Miao Lin: I went to West China Hospital in Sichuan and Southwest Hospital in Chongqing, they both said I have stones in the intrahepatic bile ducts, so I can’t do ERCP surgery, but must be operated in surgery, and it will come back. Are you sure you can do it? The Second Affiliated Hospital of Nanjing Medical University Gastroenterology Medical Center Miao Lin: I don’t know how to get the reply I just wrote, I put the content in Dr. Miao Lin’s personal website article ( Our treatment: 1, you can open the common bile duct to remove part of the stone, then put the T-tube, 2 months later through the T-tube sinusoidal choledochoscope and then take the common bile duct and intrahepatic bile duct stones. 2. Stones in the common bile duct and common hepatic duct must be treated, otherwise they will cause obstruction and jaundice and even pancreatitis. The small intrahepatic bile duct stones are less dangerous, and some of them can be discharged down to the common bile duct, and the small ones can be discharged from the common bile duct by themselves because the lower papilla has been incised. We are now also studying two methods to deal with intrahepatic bile duct stones: one is percutaneous transhepatic choledochoscopic stone extraction, first puncture PTCD to build a sinus tract, and then use choledochoscope to extract the stone, this method we have completed some people. The other method is lithotripsy by instilling lithotriptic agent through the nasal bile duct. This has been reported in foreign literature. These are all minimally invasive methods that do not require major incisions.