Management of stones in the biliary tree.

Management of stones in the biliary tree Stones in the biliary tree may coexist with gall-bladder stones, may be found only in the common duct (in the absence of gall-bladder stones) or, more rarely, may be present in the intrahepatic biliary tree -as in the Caroli syndrome.1 One of the most frequent causes of choledocholithiasis, however, is the retained common duct stone which has been left behind inadvertently after elective or emergency cholecystectomy. Despite the routine use of intraoperative cholangiography, exploration of the common duct (where indicated) at the time of cholecystectomy and even, on occasions, the use of fibre optic choledochoscopy, there is still a 1-4% incidence of retained common duct stones after cholecystectomy.2 When stones are discovered in the biliary tree, there are several therapeutic options -including, in selected patients, the use of oral chenodeoxycholic (CDCA) or ursodeoxycholic (UDCA) acid, the gall-stone dissolving agents which are more commonly used in the treatment of cholesterol-rich stones in the gall bladder.3