Korean Journal of Gastrointestinal Endoscopy 2010;41(5): 255-265.
담석의 내시경 치료
유 병 무
아주대학교 의과대학 소화기내과학교실
Endoscopic Treatment of Gallstone Diseases
Byeong Moo Yoo, M.D.
Department of Internal Medicine, Ajou Univeristy School of Medicine, Suwon, Korea
Abstract
Gallstone diseases include gallbladder stones, extrahepatic bile duct stones and intrahepatic duct stones. In the past, the main treatment modality was a surgical operation. With the development of endoscopic treatment, the main treatment modality is shifting towards endoscopic treatment. After the development of endoscopic sphincterotomy, endoscopic stone removal using a basket or balloon has been the major treatment modality for extrahepatic bile duct stones. For huge extrahepatic bile duct stones, mechanical or laser lithotripsy are used as ancillary equipment. Direct peroral cholangioscopic methods using a slim endoscopy or a Spyglass system now being rapidly developed instead of the "mother and baby" scope. If extrahapatic bile duct stones fail to be removed with peroral endoscopic treatment, then the stones can be treated via a percutaneous route (a percutaneous transhepatic route or a percutaneous transabdominal route). For intrahepatic duct stones, the location of stones, the site and degree of bile duct stricture and the existence of parenchymal atrophy are important factors to decide the treatment modality. The treatment modality is usually decided on according to the Tsunoda classification. Gallbladder stones usually need cholecystectomy because of recurrence. Endoscopic treatment is an indication for treating inoperable calculous cholecystitis patients. Endoscopic treatment for gallstone disesae will continue to rapidly develop in the future to the benefit of both the patients and endoscopists. (Korean J Gastrointest Endosc 2010;41:255-265)
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