Endoscopic treatment of symptomatic choledocholithiasis

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Biliary Tract Diseases

Background:

• Choledocholithiasis (gallstones in the bile duct) can be treated with various endoscopic techniques, including mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), laserlithotripsy (LL), and extracorporeal shock-wave lithotripsy (ESWL).
• Laparoscopic cholecystectomy is also increasingly used for stone removal in some centers.

Purpose of the Study:

• To report the treatment outcomes of choledocholithiasis using endoscopic retrograde cholangiography (ERC).
• To compare endoscopic techniques with laparoscopic stone removal through a meta-analysis of existing studies.

Main Methods:

• A total of 217 patients with symptomatic choledocholithiasis were treated between 1994 and 1995 using ERC.
• Results were compared with a meta-analysis of studies employing endoscopic and laparoscopic techniques.

Main Results:

• Complete stone removal was achieved in 98% of patients, with only 5 requiring surgery.
• Successful stone removal during the first ERC session occurred in 70% of cases.
• Additional endoscopic procedures (ML, EHL, ESWL) were needed for complete removal in 47 patients. The complication rate was 5%, including pancreatitis and bleeding; no mortality occurred.

Conclusions:

• Endoscopic retrograde cholangiography (ERC) is confirmed as the primary treatment of choice for most patients diagnosed with symptomatic choledocholithiasis.
• The study highlights the high success rate and low complication profile of endoscopic management for bile duct stones.