1. Which bile duct diseases are suitable for duodenoscopic treatment? (1) Various types of extrahepatic bile duct stones Gou Chengyue, Minimally Invasive Surgery Center, Nankai Hospital, Tianjin (2) Acute obstructive septic cholangitis, acute biliary pancreatitis (3) Biliary ascariasis (4) Benign stenosis of the lower end of the common bile duct caused by stones or chronic inflammation (5) Tumors of the bile duct or head of the pancreas 2. What are the advantages of endoscopic treatment of bile duct stones? Traditional surgical treatment of bile duct stones is inevitably traumatic, high-risk, with many complications, great pain and long hospitalization time. Many patients of advanced age or with a variety of medical diseases, excessive obesity and other patients endoscopic treatment has obvious superiority. Endoscopic treatment of common bile duct stones has been a very mature technology, does not require general anesthesia, does not require a caesarean section, the operation time is short, the patient as doing gastroscopy. At present, in developed countries, endoscopic technology has been listed as the first choice of diagnosis and treatment of patients with bile duct stones, compared with surgical endoscopic stone removal effect is better and safer. 3. What are the main symptoms of bile duct stones? One type of stone is located in the common bile duct, called choledocholithiasis, characterized by abdominal pain, chills, fever and jaundice. Choledocholithiasis can cause cholangitis, bile duct stenosis, bile duct obstruction, and liver function impairment. 4. What are the serious consequences of stones blocking the bile ducts? Bile duct stones can lead to a series of serious complications, such as acute suppurative cholangitis, pancreatitis, obstructive jaundice, etc. Jaundice, chills, high fever, elevated white blood cells, and even a drop in blood pressure, delirium and coma and other toxic shock phenomena. In the past, open surgery was needed for treatment, which was risky and had high mortality rate. Endoscopic drainage of the bile duct is safe, rapid and effective. 5. Can choledocholithiasis be removed endoscopically in all cases? What if it cannot be removed? For large stones with a diameter of more than 1.5cm, which are difficult to be removed by conventional endoscopy, mechanical lithotripsy and extracorporeal lithotripsy can be performed under duodenoscopy, and the stones can be removed by mesh basket after strangulation; or the stones are hard and cannot be crushed, and can be removed by minimally invasive triple-scope surgery after nasocholestial drainage first. 6. What are the advantages of treating benign and malignant bile duct stenosis by duodenal stent? For benign bile duct stenosis caused by repeated biliary surgery, sometimes endoscopic stent drainage is the only effective method; for malignant bile duct stenosis caused by biliary and pancreatic tumors, and the patient himself is old, with serious cardiopulmonary disease can not tolerate anesthesia and surgery, endoscopic stenting provides a safe and effective method, and even can achieve better expectations than surgery. 7. What preparations should be made before endoscopic lithotripsy? Doctor：Preoperative laboratory tests such as liver and kidney function, blood and urine amylase, bleeding and clotting time, platelet count, etc. should be performed. Obstructive jaundice or suspected bile duct obstruction or stone should pay attention to body temperature and white blood cell count and classification. Before the operation, patients and their families should explain the process of endoscopic lithotripsy in detail to obtain the active cooperation of the patients, and explain the possible complications during the operation to their families, who should sign. Ask the patient whether there is a history of iodine allergy, and do the iodine allergy test. Patients: relax and rest fully; no food or water for 8 hours before the operation; change the gown and wait for the examination and treatment. 8. What are the advantages and disadvantages of painless endoscopy? Due to cultural and individual differences in patients’ tolerance of endoscopic operation, a considerable number of patients will have anxiety and fear before the operation, and even dare not accept endoscopic examination to delay their condition. The so-called painless endoscopy (also known as conscious sedation) refers to the preoperative and intraoperative intravenous injection of moderate sedative and/or analgesic drugs for gastrointestinal endoscopy, so that the endoscopy can be completed without pain and anxiety. Compared with the general endoscopic operation, painless endoscopy has the advantages of shortening the examination time, no tension before the examination, no pain during the examination, and fast recovery after the examination; the doctor can observe the subtle lesions of the gastrointestinal tract more carefully, and carry out the minimally invasive treatment under the endoscopy more comfortably; painless endoscopy also reduces the side injuries caused by the patient’s involuntary dryness due to the pain. 9. What is the difference between ERCP, MRI and CT? The diagnostic value of ERCP can provide direct and clear images of pancreatic and biliary ducts, which has high diagnostic value for bile duct stones, bile duct tumors, bile duct stenosis and pancreatic duct diseases. It can clearly show the size, number, and extent of stenosis of the lesion, which not only has high diagnostic value, but also can be treated at the same time. CT is a computer-controlled X-ray scan of the human body, magnetic resonance imaging (MRI) is the use of the collection of signals generated by the magnetic resonance phenomenon and the reconstruction of the image of the imaging technology, CT and magnetic observation of the lesion site of the angle is different, they are non-invasive means of examination. 10. What should I pay attention to the diet after endoscopy? Patients should fast for 24 hours, check urine amylase after operation, and after normalization, they can eat fluids and gradually resume normal diet. Life should be regular, pay attention to the combination of work and rest, often participate in sports activities, eat breakfast on time, avoid getting fat, etc. is also very important preventive measures. Drinking a glass of milk every night or eating a fried egg for breakfast can make the gallbladder contract and empty at regular intervals, reducing the time bile stays in the gallbladder.