Treatments for Common bile duct stones with endoscopy

Common bile duct stones, kind of extrahepatic bile duct stones, is a common clinical disease, and accounts for 10% to 15% of cholelithiasis for the patients. If not been treated in time, it may cause serious complications such as acute suppurative cholangitis, biliary liver abscess, and biliary pancreatitis. Long-term inflammatory stimulation can even lead to the occurrence of cholangiocarcinom.

How to deal with this disease clinically is a basic skill that we must master, and this article is briefly summarizes the principles and advantages of routine clinical treatment of common bile duct stones with endoscope operation.

1. EST(Endoscopic sphinc-terotomy)

—Since its implementation in 1937, with the continuous improvement of equipment and technology, it has gradually matured, and has the advantages of simple operation, less physical trauma, fast recovery, and accurate curative effect.

—complication for EST: Early complications: mainly includes bleeding, perforation, iatrogenic pancreatitis, cholangitis and so on, the operation destroys the physiological function of the sphincter of Oddi, so it also may lead to a series of risks such as severe biliary and intestinal reflux, nipple scar stenosis, and recurrence of stones.


2. EPLBD ( endoscopic papillary large balloon dilation)

—The sphincter of Oddi been preserved, thereby preserving the sphincter function of the duodenal papilla and avoiding long-term complications associated with EST.

—The success rate for stones ≤ 1.0 cm in diameter is similar to that of EST, and for complex stone EPLBD seems to be less effective.
— Comparing with EST, EPLBD is much safer and more effevtive, especially for youth and children.
3. Endoscopic Biliary Stenting

—Biliary stenting is an effective alternative when endoscopic stone removal is difficult or the patient cannot tolerate surgery.
—The operation request long-term biliary stenting or short-term stent replacement
4. ENBD (endoscopic nasobiliary drainage)
— ENBD would reduce the risk of emergency surgery for acute cholangitis .
—tube drainage can be used as an alternative to prevent serious complications caused by papilledema and obstruction after endoscopic lithotomy.
—ENBD Those avoid repeated intubation for patients who needs repeated endoscopic treatment.
—If endoscopic stone removal operation fails, it can provide markers for stage II laparoscopic exploration.
—ENBD also can be applied for operations such as bile duct lavage, drug injection, angiography, and bile bacterial culture.


5. Endoscopic internal sphincterotomy combined with dilation balloon.
—Currently it is less commonly applied in China.
—It is applied for complicated cases of common bile duct stones as well as Bile duct stenosis due to various reasons.









Post time: May-18-2022