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Management of common bile duct stones (CBDS) affecting up to 20% of individuals with symptomatic gallstone disease is commonplace in day-to-day endoscopic retrograde cholangiography (ERCP) business as mainstay modality and platform technology in complex cases. The role of cholangioscopy in CBDS is poorly defined; however, it has been strengthened in the recently ‘Updated guideline on the management of common bile duct stones (CBDS)’ published by Williams and colleagues.1 Regarding the renewed interest in cholangioscopy in complex bile duct stone disease practice, the expert guideline strongly, although with low-level evidence, recommends cholangioscopy-directed (catheter-based) electrohydraulic or laser lithotripsy as potential best practice rescue techniques for conventional endoscopic failure, specifically including mechanical lithotripsy and/or endoscopic papillary (large) balloon dilation (EP(L)BD) after standard incision sphincterotomy. Per-oral or direct cholangioscopy (DC) versus single operator cholangioscopy and their high success rates in dedicated clinical studies derived from highly specialised centres are justifiably discussed in more detail. However, that said, the major …
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