Suggested approach for the evaluation and management of suspected choledocholithiasis^[1]

CBD: common bile duct; ERCP: endoscopic retrograde cholangiopancreatogram; EUS: endoscopic ultrasound; IOC: intraoperative cholangiogram; IOU: intraoperative ultrasonography; MRCP: magnetic resonance cholangiopancreatogram.

* A common bile duct measuring more than 6 mm in a patient with a gallbladder in situ and more than 8 mm in those that have had a cholecystectomy.

¶ Refer to UpToDate content on surgical common bile duct exploration and acute pancreatitis.

Δ If no stone is visualized on MRCP but suspicion for a CBD stone remains moderate to high (eg, in a patient whose laboratory tests are not improving), EUS is an appropriate next step.