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Some 15% of patients with gallbladder (GB) stones have concomitant stones in the bile duct (BD) believed to have migrated out from the GB. While asymptomatic GB stones may be managed expectantly, BD stones, if detected, require removal even if asymptomatic because of their potential to cause two major complications: acute cholangitis and acute pancreatitis. In patients with concomitant GB and BD stones, open surgery was standard approach but was associated with wound morbidity and T-tube-related problems. With the advent of endoscopic retrograde cholangiopancreatography (ERCP) in the 1970s, endoscopic removal of BD stones gradually received wide acceptance.1 With the …
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