Choledocholithiasis: role of US and endoscopic ultrasound

Ultrasound of the gallbladder and the biliary tree

“…To overcome this problem, the choices are either to improve the ultrasound technique (oral administration of water, position modifications, administration of fatty meals or medications to increase bile flow) either to implement more advanced modalities (endoscopic, intraoperative laparoscopic, or intraductal ultrasound) or to examine the bile ducts with magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasonography is reported to have sensitivity in detecting bile duct stones >90% and specificity >95% [52]. Similar values are reported for intraoperative and intraductal ultrasonography [53,54,55,56,57,58,59,60].…”

Endoscopic ultrasound scanning in gallstone disease

“…However, the entire length of the extra hepatic bile duct is only seen in 60 Á80% of cases [8,9]. TUS for detection of CBD stones has a sensitivity of 55 Á77% and a specificity of 83 Á95% [10]. The wide range of diagnostic values of TUS may be partly explained by its operator dependency and the size of stones in the CBD.…”

Opioid analgesia and assessment of the sonographic Murphy sign

“…Although numerous etiologies of RUQ pain exist, gallbladder disease (GBD) in the form of biliary colic and cholecystitis are among the most common, affecting roughly 25 million Americans every year and necessitating 600,000 choleycystectomies annually (1,2). The work-up of RUQ pain and the diagnosis of GBD depend heavily on the use of RUQ ultrasound (US), as the clinical and laboratory work-up for GBD has been shown to be inferior to US (3).…”