Endoscopic management of bile duct stones.

摘要: The advantages of endoscopic retrograde cholangiopancreatography (ERCP) over open surgery make it the predominant method treating choledocholithiasis. Today, technologic advances such as magnetic resonance and laparoscopic are challenging ERCP's primacy in management common bile duct (CBD) stones. This article reviews current status treatment biliary stones examines this relation to management. techniques safety sphincterotomy balloon sphincteroplasty reviewed. Balloon should be limited study protocols because questions inherent limitations. After sphincterotomy, 85% 90% CBD can removed with a Dormia basket or catheter. These described having both disadvantages. Methods for managing "difficult stones" include mechanical lithotripsy, intraductal shock wave extracorporeal chemical dissolution, stenting. approaches presented along data supporting their use specific situations. Laparoscopic cholecystectomy has emerged preferred alternative cholecystectomy. Parallel have made issue regarding optimal strategy complex. Three choledocholithiasis era follows: strict therapeutic splitting, flexible approach needs defined prospective comparative trials. For now, preoperative stone extraction still recommended choice patients suspected based on clinical, biochemical, imaging parameters. Primary evaluation is reasonable who low-to-moderate probability