Teaching Points
- The aim of investigation is to identify and treat patients with common bile duct (CBD) stones prior to surgery
- Low probability of a stone - Normal liver function tests (LFTs), normal CBD on ultrasound, previously abnormal LFTs or past history of pancreatitis
- High probability of a stone - Cholestatic jaundice, abnormal LFTs, abnormal CBD on trans-abdominal ultrasound or current episode of pancreatitis
- If surgical expertise in laparoscopic cholecystectomy, intra-operative cholangiogram and laparoscopic stone removal is available proceed directly to this option
- Non-invasive methods of evaluation include CT cholangiography, MR cholangiopancreatographyy and endoscopic US (EUS)
- Endoscopic Retrograde Cholangiopancreatography (ERCP) enables retrieval of CBD stones prior to surgery
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