Abstract
Modern cross sectional imaging methods like CT and MRCP have replaced more invasive methods for the diagnosis of cholangiolithiasis as well as benign and malignant biliary strictures. Only if a histologic or cytologic confirmation of the diagnosis is necessary, is a direct access to the biliary tract either with ERC or PTC justified as a diagnostic procedure. Due to technical advancements in laparoscopic surgery intraoperative bile duct revision has become a standard procedure for patients with choledocholithiasis discovered during cholecystectomy. It has been shown to be equally effective to ERC. In this setting ERC therefore has lost its unique claim for the treatment of bile duct stones, while it remains the treatment of choice in patients with prior cholecystectomy. In contrast ERC, sometimes in combination with PTC, has become the mainstay in the treatment of biliary lesions like leakage and benign strictures. The same is true for the palliation of malignant biliary strictures. Surgery should be reserved for patients in whom minimal invasive methods fail and for the curative treatment of malignant lesions.
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