[The problem of biliary sludge]

The authors review current literature on etiology, pathogenesis and classification of biliary sludge (BS); they analyse factors promoting formation of BS and show that ultrasonic investigation is the key diagnostic method, detecting various forms of BS and differentiating BS with parietal new-growths of the gallbladder, evaluating function of the latter and controlling efficacy of conservative therapy. Follow-up results demonstrate that BS can disappear spontaneously, be persistent in a part of patients, form stones in 20% patients. Clinical picture in BS has no specific symptoms but in 33-75% cases it is associated with development of biliary pancreatitis as a results of secondary dysfunction of the Oddi's sphincter. The latest findings on efficacy of litholytic therapy in BS and data on possible use of nonsteroid anti-inflammatory drugs as inhibitors of mucin production to prevent recurrent cholelithiasis are presented.