[Endoscopic treatment of gallstones: new technics]

Since endoscopic papillotomy and extraction of stones out of the bile duct have become established procedures, the therapeutic approach to choledochlithiasis has fundamentally changed. 80 to 90% of all stones can be extracted by this method. New techniques can be applied for larger stones or for anatomical variations of the common bile duct. Mechanical lithotripsy, a technique by which further 80 to 90% of the remaining stones can be extracted, has been perfected for clinical use. In addition, laser lithotripsy, guided by choledochoscopy, is an elegant alternative for treating large solitary concrements. Extracorporal shock wave lithotripsy, too, is a valuable technique in certain cases. Applying these new techniques has further improved therapeutic results. Despite all this progress, however, it should not be forgotten that, besides the surgical removal of bile duct stones, the condition of choledocholithiasis can, especially in old people, run a mild and uneventful course.