[Endoscopic treatment of bile duct stones and their complications].

Endoscopic treatment of bile duct stones has reached a high degree of perfection by the introduction of adjuvant therapies raising the rate of success while at the same time reducing risk. Large stones are fragmented mechanically or by means of extracorporal shock wave lithotripsy thus permitting to avoid a long and risky papillotomy. Drainage of the bile is assured with a nasobiliary drain in case of primary failure reducing the risk for cholangitis. Endoscopic treatment is the choice for residual or recurring stones after cholecystectomy and for severe purulent cholangitis in which surgical treatment is still charged with a high mortality. Endoscopic stone removal is further indicated when an operation per se carries a high risk. Long-term studies have demonstrated that even patients in which the gall bladder is preserved stay free of recurrence. In patients with severe biliary pancreatitis early papillotomy reduces complication-rate and mortality. The question remains unsettled whether patients at normal risk with simultaneous cholecysto- and choledocholithiasis should undergo direct cholecystectomy and bile duct revision or if they could profit from endoscopic removal of stones prior to cholecystectomy.