Diagnosis

• Reassure that asymptomatic stones found in biliary tree or gallbladder do not need intervention unless become symptomatic

Investigation

• LFTs and USS to those with suspected gall stone disease
• If LFTs abnormal or USS shows dilated duct but no stones, consider MRCP
• Endoscopic Ultrasound (EUS) if MRCP does not allow diagnosis

Management

Gall bladder stones

• Laproscopic cholecystectomy if symptomatic gall stones: elective day case within 1 wk
• Percutaneous cholecystostomy to manage empyema if conservative failed / surgery contraindicated

Common bile duct stones

• Bile duct clearance by ERCP then Lap Cholecystectomy
• OR Lap Chole + surgical clearance same time
• If ERCP cannot clear, then use biliary stenting

NICE Source: CG188 Gallstone disease: diagnosis and management. Summary compiled by Dr D P Sheppard MBBS.