Nonoperative management of bile duct stones.
 The treatment of choice for most retained bile duct stones is by nonoperative means.
 If a T-tube is in place, percutaneous techniques via the T-tract are indicated.
 Percutaneous access via puncture of a Roux-en-Y loop is also practical.
 In the absence of a T-tube, retrograde endoscopic techniques should be used.
 Both techniques are very effective and safe.
 Stones in the intrahepatic and extrahepatic ducts also can be treated nonoperatively.
 Endoscopic sphincterotomy has a role in the treatment of selected patients with gallstone pancreatitis, acute cholangitis, and choledocholithiasis with in situ gallbladders.
 In difficult cases, endoscopic and percutaneous techniques are employed in combination.
