Endoscopic Ultrasound in the Management of Biliary Stone Disease

  • Robert D. Fanelli
  • Todd H. Baron


Biliary stones may be silent or may cause illness ranging from mild discomfort to sepsis, acute pancreatitis, and organ failure. The evaluation of patients for common bile duct stones (CBDS) depends on the logical application of an algorithmic approach in order to deliver safe, efficient, and cost-effective care.

Clinical presentation, physical findings, biochemical analyses, transabdominal ultrasound (TUS), computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography (ERCP) all play important roles in the diagnosis of CBDS. None, however, is as effective as endoscopic ultrasound (EUS) for diagnosis.

EUS has emerged as a superior diagnostic tool for the identification of CBDS. Using EUS to direct the application of ERCP renders the latter solely a therapeutic procedure, limiting the risks and costs of unnecessary interventions. As experience with therapeutic EUS has grown, adjunctive devices are becoming available, and novel approaches to CBDS in patients with surgically altered anatomy will allow more widespread treatment options for patients with CBDS and severe illness related to biliary stone disease.


CBDS Common bile duct stones Choledocholithiasis Laparoscopic cholecystectomy Bile duct exploration ERCP EUS Endoscopic ultrasound Ultrasound Bile duct stones Gallstones Gallbladder surgery Occult common bile duct stones Gallstone pancreatitis Jaundice Cholangitis 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryThe Guthrie ClinicSayreUSA
  2. 2.Department of Medicine, Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillUSA

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