Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13382
Revised: March 23, 2014
Accepted: May 29, 2014
Published online: October 7, 2014
Core tip: Common bile duct stones (CBDS) are not infrequent in patients with gallstones and should be treated. The concept of “risk of carrying CBDS”, based on symptoms, liver serology and ultrasound, is pivotal to identify the appropriate management. While “low risk” patients do not require further examination, “intermediate to high risk” patients may be offered intraoperative cholangiography (IOC) and laparoscopic choledochus exploration, or may be referred to magnetic resonance cholangiography (MRC), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography and sphincterotomy. Whereas the results of IOC, MRC and EUS are similar in identifying CBDS, surgery seems superior to endoscopic sphincterotomy in choledochus clearance, although this latter is preferred worldwide.