Advances in endoscopic treatment of common bile duct

Cheon, Young Koog

Abstract

The advent of endoscopic retrograde cholangiopancreatography (ERCP) three decades ago had a dramatic impact on the treatment of common bile duct (CBD) stones. The advantages of ERCP over open surgery led to its widespread dissemination ad the predominant method of treating choledocholithiasis. After sphincterotomy, 85% to 90% of CBD stones can be removed with a Dormia basket or balloon catheter. These techniques are described as having both advantages and disadvantages. Methods for managing "difficult stones" include mechanical lithotripsy (ML), intraductal shock wave lithotripsy, such as electrohyhydroulic lthotripsy (EHL), laser-induced shock wave lithotripsy (LISL), extracoporeal shock wave lithotripsy, chemical dissolution, and biliary stenting. The local expertise and availability of equipment determines the choice of method used. In general, EHL or LISL is used for impacted CBD stones including stones in Mirizzi syndrome refractory to ML. ESWL is best suited for intrahepatic stones. Using currently bile duct stones still require surgical intervention.