Management of Biliary Lithiasis

Management of Biliary Lithiasis

Sean Bhalla, MD

Ryan Law, DO

Over 20 million Americans are estimated to have gallbladder disease.1 Choledocholithiasis has been estimated to be present in 10% to 20% of individuals with symptomatic gallstones.2 Biliary lithiasis can be associated with acute cholangitis and/or acute biliary pancreatitis. Choledocholithiasis often requires prompt endoscopic treatment prior to surgical cholecystectomy in symptomatic biliary lithiasis or cholangitis, to aid in resolution of pancreatitis, or to minimize subsequent episodes of pancreatitis. Nearly all bile duct stones can be treated endoscopically using various methods. Small bile duct stones can easily be extracted via sphincterotomy in conjunction with balloon or basket extraction. Large bile duct stones, defined as a stone ≥1.5 cm in diameter, can be more challenging to extract. Multiple procedures and techniques may sometimes be required in the treatment of larger stones. The American Society for Gastrointestinal Endoscopy (ASGE) provides an up-to-date guideline of endoscopic management of choledocholithiasis, but does not provide explicit guidelines or technical interventions needed for stone extraction.3 This chapter will outline and review available techniques for removal of bile duct stones.



  • 1. Coagulopathy, INR >1.5

  • 2. Baseline platelet count <50,000/mm

  • 3. Refer to Chapter 25 on Basic ERCP

May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Management of Biliary Lithiasis

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