Endoscopic management of common bile duct stones

Abstract

Common bile duct (CBD) stone is a relatively common disorder with a prevalence of 10–15% in patients with cholecystolithiasis. It is associated with severe complications, such as acute cholangitis, acute pancreatitis and obstructive cholestasis. Early diagnosis and proper endoscopic management are essential to avoid the above complications. Endosonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) have the highest accuracy in detecting bile duct stones. The standard therapy for choledocholithiasis in Germany is endoscopic retrograde cholangiography (ERC) with endoscopic sphincterotomy. As an alternative to endoscopic sphincterotomy, endoscopic papillary balloon dilation can be performed. Both procedures are equivalent in terms of technical success rate. Biliary stone extraction is then performed using a basket or balloon catheter. For difficult biliary stones further endoscopic techniques and instruments are available (including mechanical lithotripsy, cholangioscopy-guided lithotripsy and extracorporeal shock wave lithotripsy). After successful endoscopic biliary stone extraction, laparoscopic cholecystectomy should be performed within 72 hours if possible, provided there is no pancreatitis. In acute biliary pancreatitis and acute cholangitis, the severity of the disease largely determines the further endoscopic management and the need for intensive care monitoring.