Endoscopic management of common bile duct stones.

Endoscopic sphincterotomy has become the undisputed method of choice for removing common bile duct calculi following previous cholecystectomy. This approach has also been applied to selected patients with intact gallbladders deemed unfit for surgery. More recently, endoscopic clearance of the bile duct has been used in concert with laparoscopic cholecystectomy to avoid laparotomy. Modalities available for stone therapy via the endoscope include baskets and balloons, mechanical lithotripters, electrohydraulic lithotripsy probes, and laser energy. In difficult cases stents may be placed to provide drainage in lieu of stone extraction.