American Society for Gastrointestinal Endoscopy (ASGE) reported a guideline which includes a strategy for the diagnosis of choledocholithiasis.
Patient selection: symptomatic cholelithiasis
Very strong predictors of choledocholithiasis:
(1) stone in common bile duct on transabdominal ultrasound
(2) ascending cholangitis
(3) serum total bilirubin > 4 mg/dL
Strong predictors of choledocholithiasis:
(1) dilated common bile duct on ultrasound (> 6 mm) with gallbladder in situ
(2) serum total bilirubin 1.8 to 4.0 mg/dL
Moderate predictors of choledocholithiasis:
(1) age > 55 years
(2) abnormal liver function tests other than bilirubin (AST, ALT, GGT, alkaline phosphatase)
(3) chronic gallstone pancreatitis
|
Very Strong
|
Strong
|
Moderate
|
Likelihood CBD)
|
|
>= 1
|
NA
|
NA
|
high
|
|
0
|
2
|
NA
|
high
|
|
0
|
0
|
0
|
low
|
|
0
|
1
|
NA
|
intermediate
|
|
0
|
0
|
>=2
|
intermediate
|
|
0
|
0
|
1
|
?low-intermediate
|
Figure 1 of the guideline shows a management algorithm using these likelihoods.
