Non-surgical removal of common bile duct stones.

Abstract

Conventional removal of bile duct stones has been by cholecystectomy; for various reasons nonsurgical stone removal may be preferred. The majority of the procedures described aim either at destroying stones in situ or removing them from the common bile duct by mechanical means; either application requires the presence of an indwelling T-tube. The T-tube permits probes and snares to be introduced so that stones can be mechanically removed from the bile duct under radiological or endoscopic control; it also allows the stones to be irrigated with a solvent for cholesterol or with substances that permit them to be fragmented. The design of fully-flexible duodenoscopes and the development of the technique of retrograde cannulation of the common bile duct via the papilla of Vater represent the basis for the removal of common bile duct stones with the aid of endoscopic papillotomy. Complications such as pancreatitis, perforation, bleeding, and septal cholangitis have been observed, and the technique is generally limited to patients for whom surgery represents an increased risk.