[Therapeutic decision in gallstone disease from the internal medicine viewpoint]

Bile duct stones can be treated by conventional operative endoscopy in up to 90%. Stones with a diameter of up to 10 mm may be treated without endoscopic sphincterotomy (EST), larger stones require EST and subsequent mechanical lithotripsy. Extracorporeally generated shock-wave lithotripsy (ESWL) is indicated in huge (phi greater than 15 mm), hard, and intrahepatic calculi. High risk patients are palliatively treated with transpapillary stent. Symptomatic gallbladder stones require surgical therapy in up to 85%. Only selected patients are candidates for oral litholytic therapy (phi less than 10 mm) or ESWL (1-3 radiolucent stones, phi 10-30 mm). Percutaneous transhepatic litholysis is not yet established as therapeutic alternative.