Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2022; 14(7): 467-470
Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.467
Multimodal treatments of “gallstone cholangiopancreatitis”
Serafino Vanella, Mario Baiamonte, Francesco Crafa
Serafino Vanella, Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
Mario Baiamonte, General and Emergency Surgery Unit, Civico Benfratelli Di Cristina Hospital, Palermo 90121, Italy
Francesco Crafa, Oncological and General Surgery Unit, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
Author contributions: Vanella S wrote and edited the manuscript and collected the clinical data; Crafa F reviewed the discussion section of the manuscript; Baiamonte M revised the manuscript and provided recommendations for the manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Serafino Vanella, PhD, Doctor, Surgeon, Surgical Oncologist, Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, C/da Amoretta, Avellino 83100, Italy. nekroma@yahoo.it
Received: January 20, 2022
Peer-review started: January 20, 2022
First decision: March 25, 2022
Revised: April 11, 2022
Accepted: June 3, 2022
Article in press: June 3, 2022
Published online: July 16, 2022

Gallstone cholangiopancreatitis is a potentially life-threatening pathology which requires quick intervention involving endoscopists, interventional radiologists, anesthesiologists and surgeons in relation to clinical conditions. Treatment possibilities are varied, especially with current progress in advanced endoscopy, interventional radiology, and minimally invasive surgery. The following treatments are available: endoscopic sphincterotomy (ES) with stone extraction followed by laparoscopic cholecystectomy; simultaneous endoscopic stone extraction with laparoscopic cholecystectomy (rendezvous technique); combined laparoscopic cholecystectomy and common bile duct (CBD) exploration; open CBD exploration; ES post-cholecystectomy; percutaneous placement of biliary drains for unstable patients, followed by percutaneous cholangioscopy; and lithotripsy with different approaches, including a laser and balloon dilation of the sphincter of Oddi. Each technique has its strengths and weaknesses, and there is great discussion in the literature on choosing the ideal approach based on the patient’s clinical conditions.

Keywords: Cholangiopancreatitis, Common bile duct stones, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Laparoscopic common bile duct exploration, Percutaneous

Core Tip: Urgent biliary decompression represents the treatment of gallstone pancreatitis associated with cholangitis. There are different techniques for common bile duct (CBD) clearance. Endoscopic retrograde cholangiopancreatography is not always feasible, as in the case of poor clinical conditions, large stones, or biliodigestive derivations. We analyzed the different approaches for decompression of the CBD in the case of “cholangiopancreatitis”.