ADVANCES IN THERAPEUTIC ENDOSCOPIC TREATMENT OF COMMON BILE-DUCT STONES

Advances in cannulation techniques and instruments have helped in diff icult bile duct cannulation and thus stone extraction, For small commo n bile duct (CBD) stones, endoscopic papillary balloon dilatation has been proposed as an alternative to endoscopic papillotomy (EPT). The t echnique must undergo further evaluation before recommending its routi ne use, For most patients with bile duct stones, EPT remains the metho d of choice. Out of 8204 patients treated in three surgical endoscopy centers (Chile, Germany, and India), 86% to 91% of all CBD stones coul d be extracted subsequently after EPT using a Dormia basket; 4% to 7% required mechanical lithotripsy (ML) before removal and 3% to 10% of t he patients needed other sophisticated techniques, such as electrohydr aulic lithotripsy (EHL), laser-induced shock-wave Lithotripsy (LISL), or extracorporeal shock-wave lithotripsy (ESWL), The local expertise a nd 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 intrahep atic stones. Permanent stenting can be offered to poor risk patients i nstead of extensive procedures to clear the bile duct. Using currently available nonsurgical techniques, fewer than 1% of all patients with bile duct stones still require surgical intervention.