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 of CBD injury. A plastic biliary stent was placed (figure 3) with a plan to repeat ERCP in 6 weeks with a larger sphincteroplasty and covered metal stent placement to facilitate passage of clips. However, at repeat ERCP, the clips had passed spontaneously and remaining stones were removed with balloon trawl (figure 4).
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