ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence

6_Chahal_Large Stone

Pdf Summary

The document provides a detailed overview of various methods for treating large bile duct stones, focusing on endoscopic techniques and their practical applications. It is authored by Dr. Prabhleen Chahal, a distinguished professor of medicine and chief of the Division of Gastroenterology and Nutrition at the University of Texas Health, San Antonio.<br /><br />Key topics include Endoscopic Papillary Large Balloon Dilation (EPLBD), various lithotripsy techniques, and the use of stents. The text outlines the prevalence of choledocholithiasis, especially in patients with symptomatic gallstones, and emphasizes the importance of removing stones regardless of symptom presence due to increased risks of complications with larger stones.<br /><br />EPLBD is highlighted as a common technique, particularly effective when combined with Endoscopic Sphincterotomy (ES), for removing stones up to a size of 1.5 cm. Comparisons are made between using balloons and baskets for stone retrieval, with balloons generally favored for their ease of use and lower risk of stone entrapment.<br /><br />Lithotripsy methods discussed include mechanical, electrohydraulic (EHL), and laser lithotripsy. Mechanical lithotripsy is noted for its high success rate and cost-effectiveness, though it faces challenges with stones larger than 2.8 cm. EHL and laser lithotripsy are praised for their success rates but are more technically demanding and costly.<br /><br />The use of fully covered self-expandable metal stents (CSEMS) and plastic stents is also addressed, particularly in cases where immediate stone clearance is not possible. These stents help manage patients with complex conditions long-term.<br /><br />Overall, the document acts as a guide for medical professionals dealing with complex bile duct stones, offering evidence-based recommendations and practical tips based on recent studies and clinical experiences.

Keywords

bile duct stones

endoscopic techniques

Endoscopic Papillary Large Balloon Dilation

lithotripsy techniques

choledocholithiasis

Endoscopic Sphincterotomy

mechanical lithotripsy

electrohydraulic lithotripsy

laser lithotripsy

self-expandable metal stents