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Expert Rev Gastroenterol Hepatol. 2016 Jul;10(7):861-8. doi: 10.1586/17474124.2016.1145544. Epub 2016 Feb 20.

Endoscopic management of choledocholithiasis and cholelithiasis in patients with cirrhosis.

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a Digestive and Liver Diseases , Columbia University Medical Center , New York , NY , USA.
b Anniston Digestive Health , Anniston , AL , USA.
c Division of Gastroenterology and Hepatology , The Johns Hopkins University , Baltimore , MD , USA.


Treatment of choledocholithiasis and cholelithiasis in patients with cirrhosis often requires diagnostic and therapeutic endoscopy such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Patients with underlying cirrhosis may have coagulopathy, hepatic encephalopathy, ascites and other comorbidities associated with cirrhosis that can make endoscopic therapy challenging and can be associated with a higher risk of adverse events. Given the unique derangements of physiologic parameters associated with cirrhosis this population requires a truly multifaceted and multidisciplinary understanding between therapeutic endoscopists, hepatologists and anesthesiologists. For therapeutic endoscopists, it is critical to be aware of the specific issues unique to this population of patients to optimize outcomes and avoid adverse events. The epidemiology of gallstone disease, the diagnostic and therapeutic approach to patients with varying degree of hepatic dysfunction, and a review of the available literature in this area are presented.


Ascites; Choledocholithiasis; Cholelithiasis; EUS; MRCP

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