Endoscopic therapy of biliary calculi

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Biliary tract interventions

Background:

• Common bile duct stones (biliary calculi) pose a significant clinical challenge.
• Endoscopic papillotomy (EPT) has been a primary treatment modality since 1973.
• Management of refractory or complicated cases necessitates alternative therapeutic strategies.

Purpose of the Study:

• To review the efficacy and safety of endoscopic papillotomy (EPT) for common bile duct stone extraction.
• To outline alternative and adjunctive methods for managing biliary calculi when EPT is unsuccessful or contraindicated.
• To discuss the management of complications and late sequelae associated with EPT.

Main Methods:

• Review of endoscopic retrograde cholangiopancreatography (ERCP) outcomes, focusing on EPT.
• Description of various lithotripsy techniques: mechanical, electrohydraulic, and extracorporeal shock wave lithotripsy (ESWL).
• Explanation of chemical dissolution methods using agents like mono-octanoin, GMOC, MTBE, and EDTA.

Main Results:

• EPT achieves a 90% success rate for common bile duct stone extraction with a 7% complication rate.
• Hemorrhage is the most common complication (30%), rarely requiring surgery (10%).
• Lithotripsy offers an 80-90% success rate, while chemical dissolution succeeds in 50-70% of cases.

Conclusions:

• EPT is a highly effective and relatively safe procedure for common bile duct stones.
• Lithotripsy and chemical dissolution provide valuable alternatives for complex cases.
• Ongoing research explores methods like balloon dilatation to minimize late sequelae.