A 3 cm size stone in CBD near the ampulla of Vater is removed by
## **Core Concept**
The question tests the understanding of management strategies for common bile duct (CBD) stones, particularly those located near the ampulla of Vater. The ampulla of Vater is the region where the CBD and pancreatic duct empty into the second part of the duodenum. Stones in this location require specific interventions to avoid causing obstructive jaundice or pancreatitis.
## **Why the Correct Answer is Right**
The correct answer involves a procedure suitable for stones in the CBD, especially when they are close to the ampulla of Vater. **Endoscopic Retrograde Cholangiopancreatography (ERCP)** is a technique that allows for the direct visualization of the CBD and pancreatic duct. It enables the removal of stones from the CBD using a basket or balloon extraction. ERCP is particularly useful for stones near the ampulla of Vater because it allows for direct access and intervention at this site.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is blank and cannot be evaluated.
- **Option B:** This option is blank and cannot be evaluated.
- **Option C:** This option is blank and cannot be evaluated.
- **Option D:** This option is blank and cannot be evaluated.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that ERCP is not only diagnostic but also therapeutic. It is commonly used for the removal of CBD stones, especially when they are causing obstruction or are located near the ampulla of Vater. Another important fact is that sphincterotomy, which involves making a small incision in the ampulla of Vater, is often performed during ERCP to facilitate stone extraction.
## **Correct Answer:** .