NEW KNOWLEDGE ON ENDOSCOPIC TREATMENT FOR BILE DUCT STONES

Abstract

The recent progress in the treatment of bile duct stones has been remarkable, and various devices and new endoscopic procedures have been developed. Although cases with large stones or impacted stones were difficult to treat by endoscopic retrograde cholangiopancreatography (ERCP)-associated procedures in the past, now endoscopic papillary large balloon dilation (EPLBD) and peroral cholangioscopic lithotripsy (POCSL) allow for easier and more assured treatment compared with a conventional transpapillary procedure. Furthermore, cases with surgically-altered anatomy or hepatolithiasis, which generally required invasive percutaneous or surgical procedures in the past, are now successfully treated with the advent of new procedures such as balloon enteroscopy-assisted ERCP (BE-ERCP) and endoscopic ultrasound-guided antegrade treatment (EUS-AG). To treat bile duct stones safely and efficiently, it is necessary to understand each procedureʼs features and select the most appropriate procedure amongst various options according to each facilityʼs resources, the patientʼs general condition, and condition of the stone (s), and then the procedure should be performed carefully and flexibly.