DIAGNOSIS AND TREATMENT OF COMMON BILE-DUCT STONES (CBDS) - RESULTS OF A CONSENSUS DEVELOPMENT CONFERENCE

Background: Common bile duct stones (CBDS) are a frequent problem (10- 15%) in patients with symptomatic cholecystolithiasis. Over the last d ecade, new diagnostic and surgical techniques have expanded the option s for their management. This report of the Consensus Development Confe rence is intended to summarize the current state of the art, including principal guidelines and an extensive review of the literature. Metho ds: An international panel of 12 experts met under the auspices of the European Association of Endoscopic Surgery (EAES) to investigate the diagnostic and therapeutic alternatives for gallstone disease. Prior t o the conference, all the experts were asked to submit their arguments in the form of published results. All papers received were weighted a ccording to their scientific quality and relevance. The pre-consensus document compiled out of this correspondence was altered following a d iscussion of the external evidence made available by the panel members and presented at the public conference session. The personal experien ces of the participants and other aspects of individualized therapy we re also considered. Results: Our panel of experts agreed that the pres ence of common bile duct stones should be investigated in all patients with symptomatic cholecystolithiasis. Based on preoperative noninvasi ve diagnostics, either endoscopic retrograde cholangiopancreaticograph y (ERCP) or intraoperative cholangiography should be employed for dete cting CBDS. Eight of the 12 panelists recommended treating any diagnos ed CBDS. For patients with no other extenuating circumstances, several treatment options exist. Stones can be extracted during ERCP, or eith er before or (in exceptional cases) after laparoscopic or open surgery . Bile duct clearance should always be combined with cholecystectomy. Evidence for further special aspects of CBDS treatment is equivocal an d drawn from nonrandomized trials only. Conclusions: The management of common bile duct stones is currently undergoing some major changes. M any diagnostic and therapeutic strategies need further study.