Endoskopische Therapie der Choledocholithiasis

Abstract

Endoscopic Treatment of Choledocholithiasis Nowadays, treatment of common bile duct stones is usually performed by endoscopic sphincterotomy and stone removal which is an effective, efficient and safe procedure with a very low mortality. Therefore, endoscopic stone removal is the treatment of choice for patients with acute cholangitis and biliary pancreatitis. After achieving an access to the common bile duct by sphincterotomy or balloon dilation of the sphincter Oddi, endoscopic duct clearance by Dormia basket or balloon catheter is possible in at least 90%. Additional techniques including mechanical lithotripsy, extracorporeal shock wave lithotripsy, electrohydraulic and laser lithotripsy allow removal of almost all ‘difficult’ bile duct stones that are refractory to standard extraction due to their size or impaction. Endoscopic treatment of difficult biliary stones should combine several therapeutic options for maximum duct clearance and short procedure time, particularly in elderly patients. Despite the use of all endoscopic techniques, stone removal fails in 1–2%. In those rare cases, patients still require elective surgery or palliative endoprosthesis implantation. Especially younger patients with additional cholecystolithiasis should undergo cholecystectomy.