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Endoluminal Therapy for Choledocholithiasis and Cholangitis

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Multidisciplinary Approaches to Common Surgical Problems

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Abstract

Choledocholithiasis is a common cause for abdominal pain in the right upper quadrant and can be complicated by jaundice, pancreatitis and cholangitis. Noninvasive diagnostic modalities include right upper quadrant ultrasound, magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasound, in addition to the more invasive gold standard test of endoscopic retrograde cholangiopancreatography (ERCP). The definitive endoscopic treatment for either choledocholithiasis or acute cholangitis is ERCP to relieve the obstruction via extracting the stones or placing a biliary stent to achieve biliary drainage. Conventional endoscopic techniques to achieve these goals include a biliary sphincterotomy at the time of an ERCP to allow for stone extraction with the addition of a balloon sphincteroplasty for extraction of larger stones or with a tapering distal CBD. In the case of failure of conventional techniques in extracting large stones, multiple stones, intrahepatic stones, or difficult biliary access due to complex anatomy, other advanced techniques including direct cholangioscopy, endoscopic lithotripsy, or laser lithotripsy may be employed at a tertiary care center and have been shown to be effective. In the rare case of failure of endoscopic techniques, percutaneous and surgical modalities are available, although often with an increased risk of morbidity. All patients with a common bile duct stone with gallbladder in situ are recommended to be referred for a cholecystectomy, preferably within 72 hours of the stone extraction and biliary drainage to reduce the risk of recurrent pancreatobiliary events.

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  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Aditya Gutta & Mark A. Gromski

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  1. Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA

    Robert Lim

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Gutta, A., Gromski, M.A. (2019). Endoluminal Therapy for Choledocholithiasis and Cholangitis. In: Lim, R. (eds) Multidisciplinary Approaches to Common Surgical Problems. Springer, Cham. https://doi.org/10.1007/978-3-030-12823-4_18

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