What is cholelithiasis? Gallstone disease is a common and prevalent disease. Risk factors for gallstone formation include advanced age, obesity, Western diet and genetic qualities. It is estimated that at age 75, 35% of women and 20% of men will have gallstone disease. Each year, more than 500,000 people have surgery to remove stones, most of them because of symptoms. Although the disease is a major problem in Western societies, its prevalence is increasing in some regular populations with Westernized diets and in developing countries. The mechanism of gallstone formation: The main component of most gallstones is cholesterol, although some are composed of calcium salts. Bile contains large amounts of cholesterol in its usual state as a liquid. When the bile is supersaturated with cholesterol, the cholesterol becomes insoluble and precipitates out of the bile to form stones. Most gallstones are formed in the gallbladder, and most bile duct stones result from the movement of the gallbladder. Stones form in the bile ducts due to slowing and stagnation of the bile flow, such as after bile duct stricture or cholecystectomy. Common bile duct stones can lead to serious, life-threatening infections of the common bile duct (cholangitis), pancreatitis or inflammation of the liver. When the biliary system is obstructed, bacteria multiply rapidly to form bile duct inflammation, which can spread to the bloodstream and cause infection elsewhere in the body. What are the manifestations of gallstone disease? Most gallstones do not cause any symptoms for a considerable period of time, especially if the stones are located in the gallbladder. More typically, stones may pass through the gallbladder into the bile ducts and through these ducts into the small intestine without producing symptoms or remain in the bile ducts without obstructing the bile flow and generally without causing symptoms. When a stone partially or transiently obstructs the bile duct, the patient presents with pain that is recurrent and lasts for several hours, most often in the right upper abdomen, with localized pressure pain that can spread to the right scapula, often accompanied by nausea and vomiting. In combination with infection, the patient has chills, fever, and jaundice. Usually, the obstruction is temporary without co-infection. Pain due to common bile duct obstruction is not easily distinguished from pain due to gallbladder obstruction. Persistent obstruction of the cervical duct of the gallbladder causes inflammation of the gallbladder (acute cholecystitis) and obstruction of the pancreatic duct caused by stones causes inflammation of the pancreas (pancreatitis), also causing jaundice, pain and possible infection. Sometimes, intermittent pain becomes persistent after cholecystectomy, and this type of pain may be caused by common bile duct stones. Minimally invasive techniques are available for the treatment of cholelithiasis in two ways: bile duct stones can be removed, conventional surgery and endoscopic retrograde cholangiopancreatography (ERCP). The scene in “Journey to the West” where Sun Wukong borrows a fan from Princess Iron Fan is still fresh in your mind, right? Modern medicine does enable doctors to enter the human body, but not like Sun Wukong, but by using a thin, long and soft endoscope that can be connected to a TV – electronic duodenoscope, with the help of which the doctor can both see the situation inside the body and use this endoscope to perform some therapeutic operations inside the body. Endoscopic sphincterotomy is a procedure in which a gastrointestinal endoscope is fed through the mouth, through the esophagus, stomach, and duodenal bulb to the duodenal papilla (the outlet of the common bile duct) in the descending duodenum. The condition of the bile duct and the position of the incision knife can be clearly seen on the monitor connected to the X-ray machine. After incision of the duodenal papillary sphincter, the outlet of the common bile duct is opened to the appropriate size, and sometimes the flow of bile and small stones is visible after incision. The stones collected in the common bile duct are removed by entering the bile duct with a mesh basket or air bag, and then dumped “outside” like garbage, or placed in the duodenum to be excreted with feces for the purpose of treating common bile duct stones; for larger common bile duct stones, they are removed by breaking them into several pieces with a lithotripsy basket, or after sphincterotomy with extracorporeal shock wave lithotripsy. For smaller residual stones, they can be removed by themselves with the bile through the enlarged common bile duct outlet. Will there be a lot of internal bleeding that threatens human life? This fear is superfluous, the so-called duodenal papillotomy knife used in the treatment is not the shiny scalpel we know everyday, its main part is a tiny wire inserted in the duct, which can be connected to high-frequency current. After the high-frequency current is applied, the exposed wire becomes a sharp electric knife. Since the high-frequency current causes coagulation and necrosis of the tissue in contact, bleeding does not usually occur at the incision site. The so-called sphincterotomy is also different from the traditional caesarean section, in which a 1.0-1.5 cm incision is made at the duodenal papilla and the sphincter of the papilla is cut to open the end of the common bile duct. In the past 10 years, ERCP has gradually replaced the traditional caesarean section as the preferred method for the treatment of common bile duct stones in advanced countries, and is now being promoted by doctors in China, with the advantages of good safety, low cost, minimal trauma, and easy postoperative recovery, etc. It is also an effective treatment for residual stones and recurrent stones after cholecystectomy. Complications occur in 3% to 7% of patients, which is safer than abdominal surgery. Recent postoperative complications include bleeding, pancreatitis, bile duct perforation or infection, and in 2% to 6% of patients, bile duct restenosis and stone recurrence.