Review
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World J Gastrointest Endosc. Feb 16, 2014; 6(2): 32-40
Published online Feb 16, 2014. doi: 10.4253/wjge.v6.i2.32
Modern approach to cholecysto-choledocholithiasis
Lapo Bencini, Cinzia Tommasi, Roberto Manetti, Marco Farsi
Lapo Bencini, Cinzia Tommasi, Marco Farsi, Division of Surgical Oncology, Department of Oncology, Azienda Ospedaliero-Universitaria di Careggi, 50131 Florence, Italy
Roberto Manetti, Unit of Surgical Endoscopy, Department of Medicine and Emergencies, Azienda Ospedaliero-Universitaria di Careggi, 50131 Florence, Italy
Author contributions: Bencini L ideated and designed the research, as well as performed bibliographic research; Bencini L, Manetti R, Tommasi C and Farsi M also performed the research and contributed to the final draft of this paper; all the authors contributed substantially to this work.
Correspondence to: Lapo Bencini, MD, PhD, Division of Surgical Oncology, Department of Oncology, Azienda Ospedaliero-Universitaria di Careggi, Largo Brambilla 3, 50131 Florence, Italy. lapbenc@tin.it
Telephone: +39-55-7947404 Fax: +39-55-7947451
Received: November 16, 2013
Revised: January 1, 2014
Accepted: January 15, 2014
Published online: February 16, 2014
Processing time: 96 Days and 2 Hours
Abstract

Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

Keywords: Laparoscopy; Endoscopy; Laparo-endoscopic; Endoscopic retrograde cholangiography; Bile duct stones; Cholecystolithiasis; Common bile duct stones; Laparoendoscopic rendezvous

Core tip: There is no consensus on the correct strategy for the care of simultaneous gallbladder and common bile duct stones. Many therapeutic options are available, including laparoscopic, endoscopic, percutaneous and open traditional techniques, either through a combination of these treatments or by conducting them in a stepwise sequence.