Identification of gallstone disease

Oral cholecystography is the most widely used and accurate method for evaluating the gallbladder. Nonvisualization of the gallbladder on a two-day study is virtually diagnostic of cystic duct obstruction or gallbladder membrane dysfunction. Intravenous cholangiography may be used to confirm cystic duct obstruction but more commonly is used to demonstrate common-duct pathology. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography are the best studies to demonstrate the intrahepatic and extrahepatic biliary tree. Tomography may be helpful in oral cholecystography and is invaluable in intravenous cholangiography. Ultrasonography appears promising for gallbladder evaluation, but reliability is greatly influenced by the equipment available and personnel employed. Biliary drainage and bile analysis are of value in patients with negative radiographic studies and clinical symptoms suggestive of biliary tract disease.