Parasites and Biliary stones

Treatment of calcular obstructive jaundice ٨١
Endoscopic balloon dilatation (EBD) of the sphincter had previously
been performed in the 1980s but had subsequently lost favour in clinical
practice due to increased complications (mainly that of pancreatitis).
However the original risk of post-EBD pancreatitis was overestimated
due to recruitment of patients with sphincter of Oddi (SOD) dysfunction
(a group with a known increased risk of post-ERC pancreatitis) (Fujita et
al., 2003). However, the rates of pancreatitis were significantly higher for
the EBD group (7.4% versus 4.3%) but bleeding complications were
reduced (0% versus 2%). Other complication rates of infection and
perforation were similar between the two groups. Primary clearance of
the bile duct was less successful using EBD compared to ES (70% versus
80%), and the use of mechanical lithotripsy was more common (21%
versus 15%). comparing the short term complications of EBD versus ES
again confirmed an increase rate of pancreatitis with EBD versus ES
(15.4% and 0.8%, respectively) (Disario et al., 2004).
Mechanical lithotripsy (ML):
Stone removal from the common bile duct may be technically
difficult due to factors such as the size of the stone (>2 cm), impaction of
the stone in a non-dilated bile duct, stones above a bile duct stricture or a
narrowed retro-pancreatic portion of the distal CBD. In these
circumstances, mechanical lithotripsy (ML) is commonly. Bile duct
clearance rates using ML have been reported to be between 68% and 98%
(Chang et al., 2005).
Intraendoscopical lithotripsy:
Pulsated laser lithotripsy:
Laser lithotripsy uses an amplified light energy, at a particular
wavelength, which is focused into a single beam and directed onto a stone