SHM's Clinical Quick Talks-Choledocholithiasis Evaluation in Patients with Symptomatic Cholelithiasis

Pdf Summary

The document discusses the evaluation of choledocholithiasis, the presence of gallstones in the common bile duct, in patients with symptomatic cholelithiasis. It outlines the steps for evaluating patients, starting with obtaining liver function tests and a right upper quadrant ultrasound. The document categorizes patients into high, intermediate, and low likelihood of choledocholithiasis based on various factors. For patients with a high likelihood, ERCP is recommended before cholecystectomy, while those with a low likelihood can proceed directly to surgery. Patients with intermediate likelihood undergo further evaluation with modalities like MRCP or EUS.<br /><br />Various biliary imaging modalities are discussed, including CT, MRCP, EUS, IOC, and ERCP, each with its advantages and considerations. Clinical pearls highlight the importance of initial evaluation with LFTs and RUQ-US, stratifying patients based on risk, and determining the appropriate next steps based on the likelihood of choledocholithiasis.<br /><br />The document emphasizes the significance of choosing the right imaging modality based on the patient's risk level to minimize invasiveness and maximize diagnostic accuracy. Implementing the recommended approach can aid in the efficient evaluation and management of choledocholithiasis in patients with symptomatic cholelithiasis, ensuring timely intervention when necessary and avoiding unnecessary procedures when not indicated.

Asset Subtitle

Rabih Ghazi, Kevin D'Mello

Keywords

choledocholithiasis

gallstones

common bile duct

cholelithiasis

liver function tests

right upper quadrant ultrasound

ERCP

MRCP

EUS

biliary imaging modalities