Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol 2014; 20(37): 13382-13401 [PMID: 25309071 DOI: 10.3748/wjg.v20.i37.13382]
Corresponding Author of This Article
Renato Costi, MD, PhD, FACS, Dipartimento di Scienze Chirurgiche, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy. renatocosti@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Topic Highlight
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World J Gastroenterol. Oct 7, 2014; 20(37): 13382-13401 Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13382
Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy
Renato Costi, Alessandro Gnocchi, Francesco Di Mario, Leopoldo Sarli
Renato Costi, Leopoldo Sarli, Dipartimento di Scienze Chirurgiche, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
Alessandro Gnocchi, Dipartimento Materno Infantile, Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
Francesco Di Mario, Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
Author contributions: Costi R and Sarli L designed the article; Gnocchi A and Sarli L collected the data; Costi R, Gnocchi A and Sarli L analysed the data; Costi R and Gnocchi A wrote the paper; Di Mario F and Sarli L reviewed the paper for important intellectual contribution; Di Mario F and Sarli L supervised.
Correspondence to: Renato Costi, MD, PhD, FACS, Dipartimento di Scienze Chirurgiche, Università di Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy. renatocosti@hotmail.com
Telephone: +39-335-8234285 Fax: +39-521-940125
Received: January 28, 2014 Revised: March 23, 2014 Accepted: May 29, 2014 Published online: October 7, 2014
Core Tip
Core tip: Common bile duct stones (CBDS) are not infrequent in patients with gallstones and should be treated. The concept of “risk of carrying CBDS”, based on symptoms, liver serology and ultrasound, is pivotal to identify the appropriate management. While “low risk” patients do not require further examination, “intermediate to high risk” patients may be offered intraoperative cholangiography (IOC) and laparoscopic choledochus exploration, or may be referred to magnetic resonance cholangiography (MRC), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography and sphincterotomy. Whereas the results of IOC, MRC and EUS are similar in identifying CBDS, surgery seems superior to endoscopic sphincterotomy in choledochus clearance, although this latter is preferred worldwide.
