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World J Gastrointest Endosc. Jul 16, 2021; 13(7): 198-209
Published online Jul 16, 2021. doi: 10.4253/wjge.v13.i7.198
Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery
Cosmas Rinaldi Adithya Lesmana, Maria Satya Paramitha, Laurentius Adrianto Lesmana
Cosmas Rinaldi Adithya Lesmana, Maria Satya Paramitha, Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, DKI, Indonesia
Cosmas Rinaldi Adithya Lesmana, Laurentius Adrianto Lesmana, Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta 12950, DKI, Indonesia
Author contributions: Lesmana CRA provided the idea and design of the manuscript, as well as wrote the manuscript; Lesmana LA and Paramitha MS were involved in the manuscript preparation and editing.
Conflict-of-interest statement: All authors have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cosmas Rinaldi Adithya Lesmana, FACG, FACP, MD, PhD, Associate Professor, Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jl. Diponegoro 71, Jakarta 10430, DKI, Indonesia. medicaldr2001id@yahoo.com
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: May 4, 2021
Revised: May 18, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: July 16, 2021
Processing time: 114 Days and 19.5 Hours
Abstract

Common bile duct (CBD) stone is a common biliary problem, which often requires endoscopic approach as the initial treatment option. Roughly, 7%-12% of the subjects who experience cholecystectomy were subsequently referred to biliary endoscopist for further management. In general, there are three classifications of difficult CBD stone, which are based on the characteristics of the stone (larger than 15 mm, barrel or square-shaped stones, and hard consistency), accessibility to papilla related to anatomical variations, and other clinical conditions or comorbidities of the patients. Currently, endoscopic papillary large balloon dilation (EPLBD) of a previous sphincterotomy and EPLBD combined with limited sphincterotomy performed on the same session is still recommended by the European Society of Gastrointestinal Endoscopy as the main approach in difficult CBD stones with history of failed sphincterotomy and balloon and/or basket attempts. If failed extraction is still encountered, mechanical lithotripsy or cholangioscopy-assisted lithotripsy or extracorporeal shockwave lithotripsy can be considered. Surgical approach can be considered when stone extraction is still failed or the facilities to perform lithotripsy are not available. To our knowledge, conflicting evidence are still found from previous studies related to the comparison between endoscopic and surgical approaches. The availability of experienced operator and resources needs to be considered in creating individualized treatment strategies for managing difficult biliary stones.

Keywords: Difficult common bile duct stones; Endoscopic sphincterotomy; Endoscopic papillary large balloon dilatation; Mechanical lithotripsy; Cholangioscopy; Laparoscopic surgery

Core Tip: Difficult common bile duct stone is defined based on the characteristics of the stone, accessibility to papilla related to anatomical variations, and other clinical conditions or comorbidities of the patients. Currently, endoscopic papillary large balloon dilation (EPLBD) of a previous sphincterotomy or EPLBD combined with limited sphincterotomy performed on the same session is still recommended as the main approach in difficult common bile duct stone with history of failed sphincterotomy and balloon and/or basket attempts. No significant difference has been observed in mortality and morbidity rates, as well as conversion to open surgery between groups treated with a single-stage laparoscopic procedure and two-stage endoscopic and laparoscopic procedures.