What is the primary treatment for choledocholithiasis?

The primary treatment for choledocholithiasis, which is the presence of gallstones in the common bile duct, is Endoscopic Retrograde Cholangiopancreatography (ERCP) with stone extraction. ERCP is a minimally invasive procedure that allows for both diagnosis and therapeutic intervention.

During ERCP, an endoscope is passed through the mouth, esophagus, and stomach into the duodenum, where a catheter is inserted into the bile duct. This allows for imaging of the bile ducts using fluoroscopy and provides access for removal of the stones through various techniques, such as balloon sweeps or endoscopic papillotomy, effectively relieving any obstruction.

While cholecystectomy is often performed to remove the gallbladder, it is not the immediate treatment for stones lodged in the common bile duct. Laparotomy is a more invasive surgical approach that is usually reserved for complex cases or when endoscopic techniques fail. Medications alone do not address the underlying obstruction caused by the stones and therefore are not an effective treatment for choledocholithiasis.

ERCP is favored because it offers a quick and effective resolution to the problem with lower morbidity compared to more invasive surgical options.