[Endoscopic therapy of gallstones. Indications for ERCP]

Bile duct stones are associated with a high rate of severe complications such as bile duct obstruction, cholangitis and biliary pancreatitis; therefore, stones of the common bile duct should always be removed. Today the endoscopic sphincterotomy and stone removal are the therapy of choice. When the gallbladder is still present, the duct stones should be removed endoscopically before laparoscopic cholecystectomy. For difficult bile duct stones, various procedures like mechanical lithotripsy, intracorporeal shock wave lithotripsy (ISWL), intracorporeal laser lithotripsy (ILL) and extracorporeal shock wave lithotripsy (ESWL) have been shown to increase the success rate of duct clearance to up to 95 to 100%. Before laparoscopic cholecystectomy, an ERCP should be performed, if there is a history or repeated biliary colic pain, cholangitis or biliary pancreatitis, if on ultrasound the diameter of the common bile duct is greater than 6mm, or if there are signs of cholestasis in the laboratory. In acute cholangitis, urgent endoscopic sphincterotomy has been shown to decrease the morbidity and mortality rate compared to surgical interventions. In acute biliary pancreatitis, early sphincterotomy also decreases the rate of morbidity significantly.