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Multidisciplinary Management of Common Bile Duct Stones pp 151–159Cite as

Management of Choledocholithiasis in the Cirrhotic Patient

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Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) or endoscopic papillary balloon dilation (EPBD) is the most commonly used approach for choledocholithiasis in patients with cirrhosis. If this approach fails or the patient has altered anatomy, other options include transgastric ERCP with ES or EPBD, expandable stents, and/or lithotripsy. Although cirrhotic patients have some increased risk of bleeding, there appears to be no increased risk of post-ERCP pancreatitis in these patients, and they generally do well with ERCP with ES or EPBD. Because there is some risk associated with these procedures, if suspicion is not high, it is important to confirm the presence of choledocholithiasis with imaging studies, including magnetic resonance cholangiography. Surgery is an option if endoscopic management is unsuccessful. Surgical options include laparoscopic cholecystectomy with choledochotomy, laparoscopic common bile duct exploration, and T-tube placement.

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Authors and Affiliations

  1. Department of General Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave. Suite 150, Columbus, OH, 43210, USA

    Eliza W. Beal M.D. & Sylvester M. Black M.D., Ph.D.

Authors
  1. Eliza W. Beal M.D.
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  2. Sylvester M. Black M.D., Ph.D.
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Corresponding author

Correspondence to Sylvester M. Black M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. The Ohio State University Wexner Medical Center, Chief, Division of General and Gastrointestinal Surgery,, Department of Surgery,, Columbus, Ohio, USA

    Jeffrey W. Hazey

  2. The Ohio State University Wexner Medical Center, Director, Division of Gastroenterology, Hepatology, and Nutrition, Professor of Medicine, Department of Internal Medicine,, Columbus, Ohio, USA

    Darwin L. Conwell

  3. The Ohio State University Wexner Medical Center, Division of Vascular and Interventional Radiology, Department of Radiology, Columbus, Ohio, USA

    Gregory E. Guy

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© 2016 Springer International Publishing Switzerland

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Beal, E.W., Black, S.M. (2016). Management of Choledocholithiasis in the Cirrhotic Patient. In: Hazey, J., Conwell, D., Guy, G. (eds) Multidisciplinary Management of Common Bile Duct Stones. Springer, Cham. https://doi.org/10.1007/978-3-319-22765-8_16

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  • DOI: https://doi.org/10.1007/978-3-319-22765-8_16

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22764-1

  • Online ISBN: 978-3-319-22765-8

  • eBook Packages: MedicineMedicine (R0)

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