Endoscopic management of bile duct stones:Residual bile duct stones after surgery, cholangitis,and 'difficult stones'

摘要

Endoscopic treatment has become, according to the latest recommendations, thestandard treatment for common bile duct stones (CBDS), although in certain situations, surgicalclearance of the common duct at the time of laparoscopic cholecystectomy is still considereda possible alternative. The purpose of this article is not to compare endoscopic with surgicaltreatment of CBDS, but to describe the various techniques of endoscopic treatment, detailingtheir preferential indications and the various treatment options that must sometimes be con-sidered when faced with ‘‘difficult calculi’’ of the CBD. The different techniques of lithotripsyand the role of biliary drainage with plastic or metallic stents will be detailed as well as papil-lary balloon dilatation and particularly the technique of sphincterotomy with macrodilatationof the sphincter of Oddi (SMSO), a recently described approach that has changed the strategyfor endoscopic management of CBDS. Finally, the overall strategy for endoscopic managementof CBDS, with description of different techniques, will be exposed.