[Diagnosis of common bile duct stones in symptomatic gallstone disease]

It is unclear which diagnostic procedure is optimal for the detection of common bile duct stones prior to laparoscopic cholecystectomy. It is routine to use blood tests for liver function and transabdominal ultrasound, and the best method is currently to continue evaluation with other methods when one or more blood tests for liver function are elevated and/or the diameter of the common bile duct is > or = 10 mm on transabdominal ultrasound. Magnetic resonance cholangiography, endoscopic ultrasound, laparoscopic ultrasound, intraoperative cholangiography and endoscopic retrograde cholangiography are all accurate in the detection of common bile duct stones. Intravenous cholangiography and computer tomography needs further evaluation before final recommendations can be made. Intraoperative cholangiography and endoscopic retrograde cholangiography have the best documentation available in the literature. Intraoperative cholangiography is easy, cheap and without significant complications, whereas endoscopic retrograde cholangiography has a high morbidity and mortality rate. Endoscopic retrograde cholangiography is therefore not suitable as a diagnostic test and should be abandoned as such in the future. Patients with cholangitis, jaundice and common bile duct stones visualised by transabdominal ultrasound have a high risk of common bile duct stones, and these patients can therefore undergo endoscopic retrograde cholangiography directly. Other patients should have a magnetic resonance cholangiography or endoscopic ultrasound preoperatively, or intraoperative cholangiography or laparoscopic ultrasound depending on local factors such as available equipment and surgical expertise.