Eduard Veseliny, Martin Janíčko, Peter Jarčuška
Common bile duct (CBD) stones can be classified into primary stones (those that form within the bile ducts) and secondary
stones (those that originate from the gallbladder). The majority of bile duct stones are secondary cholesterol stones
in the western population. Due to the risk of complications including cholangitis, sepsis, biliary pancreatitis and
secondary biliary cirrhosis, even stones in asymptomatic patients should be extracted if feasible. Magnetic resonance
cholangiopancreatography and endoscopic ultrasound have good accuracy in detecting choledocholithiasis when there
is an intermediate probability of harbouring a bile duct stone. Endoscopy is widely accepted as the first treatment option
in the management of bile duct stones. Most biliary stones can be removed using conventional techniques involving
sphincterotomy, balloon dilation, and balloon or basket extraction with high success rates averaging 90-95%. Development
of instruments and techniques such as endoscopic sphincterotomy with large balloon dilation of the sphincter,
mechanical lithotripsy, electrohydraulic lithotripsy, laser lithotripsy has enabled successful clearance of the biliary
tract in difficult cases with rates ranging from 77 to 98%. In patients with significant comorbidities which make surgical
or aggressive endoscopic therapy impossible, biliary stenting with plastic stents can be used as a temporising solution
for biliary drainage. In this review, we focused on aetiopathogenesis, clinical symptomatology, diagnosis and therapy
of choledocholithiasis with emphasis on endoscopic management.