Biliary Calculi

  • Masatsugu Nagahama


Cholelithiasis is one of the most common gastrointestinal disorders. Cholelithiasis is divided into gallbladder stone, common bile duct stone, and intrahepatic stone by site of development. Each type develops either secondarily to other conditions or independently. When asymptomatic common bile duct stones are detected, they are highly likely to become symptomatic. Thus, aggressive treatment is basically recommended regardless of the presence or absence of symptoms. Endoscopic treatment of common bile duct stones is established as the first treatment of choice for common bile duct stones at many facilities worldwide. Endoscopic sphincterotomy (EST) is usually performed in Western countries. However, in Japan, endoscopic papillary balloon dilation (EPBD) as well as EST is performed at many institutions. When the stone diameter exceeds the diameter of the EST- or EPBD-treated papilla, they need to be fragmented and removed through the papilla. Lithotripsy procedures include endoscopic mechanical lithotripsy (EML) and peroral cholangioscopy-guided electrohydraulic shockwave lithotripsy. In recent years, endoscopic papillary large balloon dilation (EPLBD) has come into clinical use.


Common bile duct stone EST EPBD 


  1. 1.
    Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172–87.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1–9.CrossRefGoogle Scholar
  3. 3.
    Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57(7):1004–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Clayton ES, Connor S, Alexakis N, et al. Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg. 2006;93(10):1185–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Sohma S, Ichikawa T, Okamoto Y, et al. Endoscopic papillotomy: a new approach for extraction of residual stones. Mexico: The IIIrd International Congress of Gastrointestinal Endoscopy; 1974. p. 19–21.Google Scholar
  6. 6.
    Kawai K, Akasaka Y, Murakami K, et al. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974;20(4):148–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Classen M, Demling L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct (author’s transl). Dtsch Med Wochenschr. 1974;99(11):496–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Staritz M, Ewe K, Meyer zum Büschenfelde KH. Endoscopic papillary dilatation, a possible alternative to endoscopic papillotomy. Lancet. 1982;1(8284):1306–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Mac Mathuna P, White P, Clarke E, et al. Endoscopic sphincteroplasty: a novel and safe alternative to papillotomy in the management of bile duct stones. Gut. 1994;35(1):127–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Komatsu Y, Kawabe T, Toda N, et al. Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases. Endoscopy. 1998;30(1):12–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Bergman JJ, Rauws EA, Fockens P, et al. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones. Lancet. 1997;349(9059):1124–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Vlavianos P, Chopra K, Mandalia S, et al. Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial. Gut. 2003;52(8):1165–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fujita N, Maguchi H, Komatsu Y, et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial. Gastrointest Endosc. 2003;57(2):151–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Disario JA, Freeman ML, Bjorkman DJ, et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004;127(5):1291–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Masatsugu Nagahama
    • 1
  1. 1.Division of GastroenterologyShowa University Fujigaoka HospitalYokohamaJapan

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