Diagnosis and treatment of common bile duct stones

Abstract

Since most common bile duct stones (CBDS) are symptomatic, and cholangitis or biliary pancreatitis can be severe, the diagnosis and treatment of CBDS are important. Among diagnostic modalities such as abdominal ultrasonography, CT, MRI and endoscopic ultrasonography (EUS), the sensitivity of EUS is high, especially for small CBDS. Tokyo Guidelines are useful for the diagnosis of cholangitis with higher sensitivity compared to the classical Charcot's triad. ERCP with endoscopic sphincterotomy (EST) is the current standard of care for CBDS. In addition to endoscopic mechanical lithotripsy (EML) for large CBDS, usefulness of endoscopic large balloon dilation (EPLBD) and peroral cholangioscopy (POCS) with lithotripsy is increasingly reported. Furthermore, CBDS in cases with surgically altered anatomy can be endoscopically managed, using balloon-assisted endoscopy or EUS, too. The role of endoscopy will increase further for management of CBDS.