[Symptomatic common bile duct lithiasis: endoscopic treatment or surgical treatment?]

Since 1974, endoscopic sphincterotomy (ES) has been considered by most practitioners as the gold standard for the treatment of symptomatic common bile duct lithiasis (CBDL). Results of the seven prospectives randomized controlled trials comparing ES to surgery in the treatment of CBDL, acute pancreatitis and angiocholitis excluded, demonstrated that: 1) the rate of feasibility of ES ranged from 90 to 100%; 2) the rate of residual stones after first extraction attempt ranged from 4 to 23% and after second extraction attempt from 6 to 25%. After surgery, rate of residual stone ranged from 2 to 14%; 3) major complications were more frequent after ES than after surgery; on the opposite, minor complications were more frequent after surgery than after ES; 4) immediate mortality was higher after ES than after surgery; 5) cost of ES with or without de principle cholecystectomy was higher than surgery. In conclusion ES should not be the first treatment of symptomatic CBDL.