Gallstone disease other imaging findings

There are other imaging modalities that can be useful in diagnosing gallstone disease, these include; endoscopic retrograde cholangiopancreatography (ERCP), bile microscopy and oral cholecystography. It should be noted however, that some of these have been replaced by non-invasive, more advanced and less expensive imaging techniques.

• Endoscopic retrograde cholangiopancreaticogram (ERCP) is an invasive procedure that requires technical expertise and often performed by inserting a tube into the common bile duct while the patient is sedated.^[1][2][3]
• Contrast material is then injected to allow visualization of the biliary tree.
• Traditionally, ERCP was not only diagnostic but is also therapeutic, so that if a stone was detected, it could be removed in the same sitting.
• The sensitivity of ERCP for choledocholithiasis is estimated to be 80 – 93%.
• ERCP has largely been replaced by MRCP and is now reserved for patients at a high risk of having a common bile duct stone, particularly with cholangitis.

• Oral cholecystography is rarely done since being replaced by the transabdominal ultrasound.^[5]
• It is still occasionally used prognostically to evaluate gall bladder function in obese patients on medical dissolution therapy such as ursodeoxycholic acid where a high quality ultrasound cannot be obtained.

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