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This article, titled "Unusual access for biliary cholangioscopy with lithotripsy: every cloud has a silver lining," presents a case study of a complex clinical scenario involving cholangitis. The authors highlight the importance of intuition and innovative use of advanced endoscopic devices in solving the case. They demonstrate how cholangioscopy through an unconventional access to the biliary tract allowed for less invasive drainage of the biliary tree and extraction of stones. The authors emphasize the versatility of this device in clinical practice. [Extracted from the article]

The article discusses the challenges of performing endoscopic biliary drainage (BD) in patients with altered anatomy, which reduces the chances of success compared to patients with standard anatomy. The study, conducted in multiple Italian centers, aimed to explore the different approaches to BD in patients with altered anatomy and the number of attempts required. The results showed that interventional endoscopic ultrasound (EUS) had a higher clinical success rate compared to device-assisted enteroscopy (DAE). However, a significant proportion of patients required multiple attempts to achieve success. The study concludes that despite the sub-optimal success rate, interventional EUS is an effective option for patients with altered anatomy. [Extracted from the article]