الفهرس 
Endoscopic retrograde cholangiopancreatography (ERCP)Only 14 pages are availabe for public view
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Abstract
Bile duct stone management has changed dramatically in the last two decades when open surgery has been replaced by per-oral endoscopic procedures. Nowadays, therapeutic ERCP is performed worldwide as the first approach in the management of extrahepatic bile duct stones and is superior to surgical or percutaneous approaches, although it can be challenging in some cases.Endoscopic therapy involves stone extraction using conventional methods after performing endoscopic biliary sphincterotomy. The routine devices used for stone retrieval are balloon catheters, Dormie baskets and mechanical lithotripters. In the last thirty years, endoscopic biliary sphincterotomy (EST) is considered the established method for bile duct Stone extraction and it is well known that the great majority of the stones can be successfully removed by using conventional techniques. However, stone removal can be difficult and unsuccessful in less than 10% of cases, when managing large, barrel-shaped, piston-like, multiple stones structured common bile duct (CBD) or in cases of altered anatomy.Endoscopic papillary balloon dilation (EPBD) was first introduced in 1982 by Staritz et al. Due to the advantages of reduced risks of bleeding and perforation and the successful application in patients with surgically altered anatomy, EPBD is an alternative to EST in patients with common bile duct stones. EPBD protects the function of papillary sphincter; however, it may be accompanied by increased rates of post-endoscopic complications.Lithotripsy is an endoscopic technique used to catch common bile duct stones that are too large to be removed by conventional methods. Endoscopic methods of lithotripsy include intraductal electrohydraulic lithotripsy, laser