Abstract
A major advantages of ERCP and percutaneous transhepatic cholangioscopy (PTCS) exist in facilities of non-surgical therapeutic procedure. Endoscopic sphincterotomy (EST) has been contributed for a relief from choledocholithiasis, acute pancreatitis caused by choledocholithiasis, acute cholangitis, benign bile duct stricture and malignant obliteration. At present time peroral cholangioscopy becomes to be in practice for further investigation and lithotripsy using electro-hydraulic lithotriptor or pulsed dye laser. Successful outcome was also obtained by an application of extracorporeal shock wave lithotripsy for the choledocholithiasis up to 85% combined with EST. Success rate of bile duct lithotripsy has been achieved over 90 % so far, however a risk of complication was minimal in 7.2% of morbidity and in 1 0 or less of mortality. Difficult ES I has been existed, but could be treated combination of PTCS. ESWL and PCPS. Endoscopic decompression technique (EBD) offers a continuous internal drainage of bile with indwelling of large bore straight stent, 8F.10F, 12F, 14F, sized, to get better quality of life for the patient with inoper able obstructive jaundice. Success rate was 83 %, but late complication of clogging of the stent and cholangitis up to 30-50 %. We have a history of EST for 17 years. Follow-up study showed higher recurrence rate of bile duct calculi up to 11.4% to 25%. Accord-ing to Yamakawa's report, intrahepatic bile duct calculi were more commonly reccured 50% in 5 years. Most of the cases reccurred were significantly, associated with gall bladder calculi in situ. Recommendation could be made to receive surgical or laparoscopic cholecystectomy later on for those patients with gall bladder calculi in situ. First of all EST should be conducted for acute supurative fatal cholangitis as a first choice of treatment, and also for acute pancreatitis associated with choledocholithiasis.
