Clinical significance of biliary sludge

Although biliary sludge has been considered to be a benign condition associated with factors promoting bile stasis, its clinical significance and whether it contributes to biliary tract symptoms are uncertain. We conducted a retrospective review of patients with ultrasonographic diagnosis of biliary tract sludge during the 6-year period from 1979 to 1985. Of the 87 patients with gallbladder sludge alone, 11 (13%) had definite clinical findings and evolving laboratory abnormalities consistent with acute biliary tract disease. Four of these 11 patients proved to have gallstones at the time of surgery, while three had sludge alone as the apparent cause of their biliary tract symptoms. The clinical illness in four remaining patients resolved with medical therapy. We conclude that gallbladder sludge, as defined by ultrasound, may be associated with acute biliary tract disease.