Role of EUS in suspected choledocholithiasis

What is the role of EUS in suspected choledocholithiasis? 

  • This depends on the probability of choledocholithiasis being present based on clinical and imaging findings.
  • In patients with high probability of choledocholithiasis (total bilirubin > 4 mg/dL or common bile duct (CBD) stone seen on radiologic imaging, or both dilated CBD with bilirubin 1.8-4 mg/dL), ERCP should be performed without further testing, whereas patients with low probability of stones may be managed conservatively.
  • EUS is indicated in patients with intermediate probability of choledocholithiasis (abnormal liver function tests other than bilirubin, clinical gallstone pancreatitis, age > 55 years).

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