Diagnosis and treatment of common bile duct stones: a current review and the Berne concept
Schäfer, M.; Krähenbühl, L.; Büchler, M.W.
Schweizerische Medizinische Wochenschrift 129(16): 624-630
1999
ISSN/ISBN: 0036-7672 PMID: 10378246 Document Number: 509124
The prevalence of common bile duct stones increases with age. Whereas patients under 60 show a prevalence of 8-15%, the rate increases up to 15-60% > 60 years. The main goal of optimal preoperative diagnosis and treatment of bile duct stones is to avoid unnecessary and negative investigations and to decrease the rate of retained/missed stones. Anamnestic and clinical pointers, laboratory findings and "simple" radiological examinations (ultrasonography, intravenous cholangiography) allow selective preoperative ERCP. The reported clearance rates for ERCP are as high as 95%, with a morbidity and mortality of 3-15% and 0.2-2.5% respectively. Only after endoscopic stone removal should laparoscopic cholecystectomy be added. Laparoscopic bile duct exploration is technically demanding and offers no objective advantages compared to ERCP.