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The endoscopic treatment of calculi of the main biliary duct (CMBD) has been performed in France since 1974. One of us (Cl. L.) published his results with a series of 323 patients in 1979. The stones were extracted in 86.5% of all cases, the failures being caused by the impossibility to perform endoscopic sphincterotomy (ES) in 4.3% of cases or to extract the stones in 9.2%. Since that date, a number of factors helped improving the effectiveness of endoscopic treatment: the increasing experience of the surgeons, the improvement of endoscopes, especially more appropriate optics (wide angle and 15 degrees retrograde vision) and the endoscopic approach of the biliary tract, the use of intraoperative radiology allowing access to the biliary tract in all cases, and the development of extra- and intracorporeal lithotrity solving the problem of stones that cannot be extracted by conventional means. This work is aimed at demonstrating the current possibilities of the endoscopic treatment of lithiasis of the CMBD in a Hospital using plain radiology and lithotrity.

Instillation of Methyl tert-butyl ether in the gallbladder permits the dissolution of cholesterol stones. Percutaneous transhepatic puncture of the gallbladder is the currently used approach; but shortcomings of this procedure could make the transpapillary cannulation of the cystic duct preferable. The reproducibility of this procedure, however, is not established. "In situ" dissolution is useful in cases of multiples stones which are not amenable to treatment with extra corporeal shock wave lithotripsy (ESWL). It can also be complementary to standard ESWL by promoting rapid disappearance of stones fragments. Preliminary results obtained in 9 patients suggest the necessity of rigorous selection criterias particularly regarding the chemical nature of the stones.