Endoscopic treatment of symptomatic choledocholithiasis.
OBJECTIVE
Today, different endoscopic techniques are available to treat choledocholithiasis. These techniques include mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), laserlithotripsy (LL), and extracorporal shock-wave lithotripsy (ESWL). These techniques have to compete with laparoscopic stone removal which is performed with increasing frequency at some centers.


METHODS
We report the results of treatment of choledocholithiasis and compare the results with a meta-analysis of studies in whom endoscopic and laparoscopic techniques were applied. From 1994-1995, 217 patients with symptomatic choledocholithiasis were treated using endoscopic retrograde cholangiography (ERC).


RESULTS
Overall, complete stone removal was successful in 98% of all patients and only 5 patients had to undergo surgery. Complete endoscopic removal of stones was achieved in 70% during the first ERC session. In 47 patients consecutive ERC sessions with application of EML, EHL, or ESWL were necessary to completely remove the stones. Complication rate was 5% and included pancreatitis and bleeding from papillotomy. There was no procedure-related mortality.


CONCLUSIONS
The study suggests that today ERC remains the treatment of choice in most patients with symptomatic choledocholithiasis.
Department of Gastroenterology and Infectiology, Heinrich-Heine-University of Dusseldorf, Germany.
B
B
Schumacher
T
T
Frieling
D
D
Haussinger
C
C
Niederau
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000706:statistics & numerical data; D042882:Gallstones / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D008096:Lithotripsy / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome