Gallstone disease : Diagnostic tests

For primary care clinicians, accurately diagnosing gallstone disease requires a systematic approach that balances efficacy, safety, and practicality of diagnostic tests. Gallstones can manifest with a range of abdominal or gastrointestinal symptoms, making thorough evaluation crucial for effective management. The initial diagnostic tool of choice is an abdominal ultrasound examination, prized for its non-invasiveness, accuracy in detecting gallbladder stones, and wide availability. However, its limitation lies in potentially missing stones in the common bile duct.

To complement ultrasound findings, liver function tests (LFTs) are recommended, especially if gallstones in the common bile duct are suspected, as indicated by abnormal results or persistent symptoms despite initial management. When these initial assessments suggest, but do not confirm, the presence of common bile duct stones, further investigations become necessary.

Magnetic Resonance Cholangiopancreatography (MRCP) offers a non-invasive yet highly accurate means of diagnosing common bile duct stones, especially when ultrasound results are inconclusive or suggest bile duct dilation. It does not expose patients to ionizing radiation, making it a favorable option. However, its availability and cost may limit its use in certain settings.

Endoscopic Ultrasound (EUS) is reserved for cases where MRCP is inconclusive, providing the highest diagnostic accuracy for common bile duct stones....