Bile Duct Stones

Common bile duct stones (CBDS) incidence is about 10–15%. Clinical signs and symptoms are nonspecific but when associated with biochemical tests and abdominal ultrasound, patients can be categorized into low, intermediate, and high risk of choledocholithiasis. These clinical, biochemical, and radiological predictors will direct the diagnostic approach through cholangio magnetic resonance, endoscopic ultrasound, laparoscopic ultrasound, or intraoperative cholangiography. Treatment options must consider technological availability, technical skills, stone size, and bile duct diameter. In general, it involves endoscopic retrograde cholangiopancreatography or surgery for CBDS clearance. For difficult stones, endoscopic sphincterotomy followed by large balloon dilation, mechanical lithotripsy, cholangioscopy-guided lithotripsy, and extracorporeal shock wave lithotripsy are described, mainly as a bridge procedure