Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Common Bile Duct Stones: Diagnosis

Abstract

The diagnosis of common bile duct (CBD) stones is conducted through various imaging tests, endoscopic examinations, and the patient's clinical presentation. In patients with symptomatic gallstone disease, initial tests such as liver function tests, abdominal ultrasound, and abdominal computed tomography can be performed. Based on the results of these initial tests, symptomatic patient with cholelithiasis can be classified into low risk, intermediate risk, and high risk groups. Low risk of choledocholithiasis is characterized by normal liver function test results and absence of CBD dilation on abdominal ultrasound. For patients in this category, additional tests are not necessary unless symptoms indicating CBD stones persist. Intermediate risk of choledocholithiasis is identified by abnormal liver function test results or CBD dilation on abdominal ultrasound. Additional tests such as endoscopic ultrasound or magnetic resonance cholangiopancreatography can be performed. If CBD stones are confirmed in the additional tests, endoscopic retrograde cholangiopancreatography (ERCP) is required. High risk of choledocholithiasis is diagnosed when there is clinical evidence of cholangitis or CBD stones are identified on imaging tests. In such cases, ERCP is recommended for both diagnosis and treatment purposes without the need for further additional tests.