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World J Gastroenterol. May 28, 2006; 12(20): 3162-3167
Published online May 28, 2006. doi: 10.3748/wjg.v12.i20.3162
Choledocholithiasis: Evolving standards for diagnosis and management
Marilee L Freitas, Robert L Bell, Andrew J Duffy
Marilee L Freitas, Robert L Bell, Andrew J Duffy, Department of Surgery, Yale University School of Medicine, 40 Temple Street, Suite 3A, New Haven, CT 06510, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Andrew J Duffy, MD, Department of Surgery, Yale University School of Medicine, 40 Temple Street, Suite 3A, New Haven, CT 06510, United States. andrew.duffy@yale.edu
Telephone: +1-203-7469060 Fax: +1-203-7469066
Received: March 29, 2006
Revised: April 7, 2006
Accepted: April 16, 2006
Published online: May 28, 2006
Abstract

Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones.

CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones.

The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation.

Keywords: Choledocholithiasis; Laparoscopy; Diagnosis; Treatment; Cholangiogram