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Gallstone disease and its complications place a substantial burden on healthcare services, with common bile duct calculi having the potential to cause significant morbidity and mortality, particularly following the occurrence of ascending cholangitis or pancreatitis. Due to these potential risks it is important, when present, to accurately identify common bile duct calculi in patients with gallstone disease. There are a number of investigations available to aid clinicians in the identification of choledocholithiasis. The aim of this review is to evaluate the current evidence and the up-to-date practice within western populations.
A literature review was performed using the Medline database.
The reliability of trans-abdominal ultrasound scans and liver function tests in accurately identifying common bile duct calculi were found to be poor. Risk stratification using algorithms incorporating both tests, together with clinical factors, were also found to be inadequate for accurately predicting choledocholithiasis. Based on initial screening further assessment in intermediate and high-risk groups is suggested to avoid unnecessary invasive investigations and therapeutic procedures, which themselves are associated with a significant rate of complications.
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