Non-operative Management of Common Bile Duct Stones: ERCP and Other Techniques (Lithotripsy)

For decades, when common bile ducts stones were suspected, palpated, or demonstrated by operative cholangiography, formal choledochotomy and bile duct exploration were the preferred approach for their removal. Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP), the management of choledocholithiasis has increasingly become a non-operative endeavor. The current literature demonstrates that non-operative management has far greater than 90% efficacy. In this chapter we discuss some of the basic principles of ERCP and address adjunctive maneuvers and techniques to evacuate stones and debris from the common bile duct. We also discuss percutaneous, and hybrid techniques, particularly useful when ERCP fails. Finally we look toward the horizon and other techniques and technologies that may become more common place in the future.