Open AccessModern approach to cholecysto-choledocholithiasis
Author(s) -
Lapo Bencini
Publication year - 2014
Publication title -
world journal of gastrointestinal endoscopy
Language(s) - Uncategorized
Resource type - Journals
ISSN - 1948-5190
DOI - 10.4253/wjge.v6.i2.32
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , gallstones , common bile duct , jaundice , general surgery , cholecystectomy , acute pancreatitis , gold standard (test) , intensive care medicine , laparoscopic cholecystectomy , pancreatitis , bile duct , common bile duct stone , gallbladder , surgery
Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.