[State of the art in therapeutic biliary endoscopy]

Almost all biliary diseases are now amenable to endoscopic treatment. Progress in therapeutic biliary endoscopy is currently focusing on identifying the best treatment options to be used in each case in relation to available evidence: how should a malignant stricture of the common bile duct or hilium be drained? How should a "difficult" biliary stone be extracted? How should an external biliary fistula be treated? What should one do with the gallbladder after extraction of common bile duct stone? Should sedation or general anesthesia be offered? Progress has been made in the technique of endoscopic ampulectomy and in developing new devices to improve the success rate of endoscopic retrograde cholangiopancreatography.