Suspected common bile duct stones (algorithm)

Abstract

Common bile duct stones can be suspected in a patient presenting with biliary type colicky pain, elevated liver enzymes, jaundice, cholangitis or pancreatitis. Beside clinical features, laboratory evaluation and adequate abdominal imaging (primarily abdominal ultrasound) help to assess the likelihood for the presence of CBDS. Recent ESGE guidelines recommend direct ERCP in patients with visible stones or cholangitis only. In other cases (intermediate likelihood) EUS or MRCP before ERCP are recommended.