Endoscopic Ultrasonography (EUS) in Diagnostics and Treatment of Bile Duct Stones. The Current Role of ERCP
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Oddział Chorób Wewnętrznych, Pracownia Endoskopii, Samodzielny Publiczny Zespół Zakładów Opieki Zdrowotnej w Staszowie
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Jacek Kiełtucki   

Oddział Chorób Wewnętrznych, Pracownia Endoskopii, Samodzielny Publiczny Zespół Zakładów Opieki Zdrowotnej w Staszowie
Ann. Acad. Med. Siles. 2017;71:326-330
Precise evaluation of the presence of bile duct stones, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound – US) but also more sophisticated imaging methods (CT or MRI) are frequently unreliable. The optimal method of bile duct stone non-invasive diagnostics is magnetic resonance cholangiography. The role of endoscopic retrograde cholangiopancreatography in diagnostics has receded into the background due to the possibility of numerous serious complications. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, diagnostic endoscopic ultrasonography followed by simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis. The use of endoscopic ultrasonography allows one to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the ampulla of Vater followed by mechanical evacuation of stone deposits from the ducts still remains a the optimal procedure in the treatment of choledocholithiasis.
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