Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

Table 1 Common bile duct stones diagnosis and management: Current evidence

Biliary lithiasis affects 10% to 20% of general population and is associated with CBDS in up to 20% of cases

Clinical symptoms, liver/pancreas serology and transabdominal ultrasounds may define the “risk of carrying CBDS”, and identify:

“Low risk” patients, to be directly referred to laparoscopic cholecystectomy

“Intermediate risk” patients, needing intraoperative cholangiography, endoscopic ultrasounds or magnetic resonance cholangiography before laparoscopic cholecystectomy

“High risk” patients requiring endoscopic retrograde cholangiography

CBDS may be managed by endoscopic sphincterotomy or surgery (laparoscopic or open). This latter has seemingly slightly better results, counterbalanced by invasiveness (open surgery) or the need of specific instrumentation and advanced laparoscopic skills (laparoscopic surgery). Lithotripsy may help endoscopic CBDS retrieval or may be performed extra-corporeally in selected, unfit patients

CBDS management will be more and more multidisciplinary and tailored not only on a specific patient but also on the available resources of a specific environment to have the best possible management

CBDS: Common bile duct stones.