Algorithm for the Management of Patients with Symptomatic Cholelithiasis - Flowchart
Algorithm for the Management of Patients with Symptomatic Cholelithiasis - Flowchart Choledocholithiasis Choledocholithiasis
«Flowchart»

Symptomatic patient with cholelithiasis

Symptomatic patient with cholelithiasis

Symptomatic patient with cholelithiasis

Symptomatic patient with cholelithiasis

Preoperative ERCP

Preoperative ERCP

Preoperative ERCP

Preoperative ERCP

End

End

End

End

Laparoscopic cholecystectomy
No cholangiography

Laparoscopic cholecystectomy
No cholangiography

Laparoscopic cholecystectomy
No cholangiography

Laparoscopic cholecystectomy
No cholangiography


Likelihood of CBD stone based on clinical predictors

Likelihood of CBD stone based on clinical predictors

Likelihood of CBD stone based on clinical predictors

Likelihood of CBD stone based on clinical predictors

LOW

LOW

LOW

LOW

INTERMEDIATE
Abnormal liver chemistries/age >55/dilated CBD on imaging

INTERMEDIATE
Abnormal liver chemistries/age >55/dilated CBD on imaging

INTERMEDIATE
Abnormal liver chemistries/age >55/dilated CBD on imaging


INTERMEDIATE

HIGH
Any one of three:


    CBD stone seen on imaging
    Elevated serum bilirubin (>4 mg/dl) and CBD dilation on imaging
    Clinical evidence of cholangitis

HIGH
Any one of three:


    CBD stone seen on imaging
    Elevated serum bilirubin (>4 mg/dl) and CBD dilation on imaging
    Clinical evidence of cholangitis

HIGH
Any one of three:



    CBD stone seen on imaging
    Elevated serum bilirubin (>4 mg/dl) and CBD dilation on imaging
    Clinical evidence of cholangitis

CBD stone seen on imaging
Elevated serum bilirubin (>4 mg/dl) and CBD dilation on imaging
Clinical evidence of cholangitis HIGH

Laparoscopic IOC or laparoscopic ultrasound

Laparoscopic IOC or laparoscopic ultrasound

Laparoscopic IOC or laparoscopic ultrasound

Laparoscopic

Preoperative EUS or MRCP

Preoperative EUS or MRCP

Preoperative EUS or MRCP

Preoperative

If positive: Laparoscopic CBD exploration OR postoperative ERCP

If positive: Laparoscopic CBD exploration OR postoperative ERCP

If positive: Laparoscopic CBD exploration OR postoperative ERCP

If positive

If negative: Laparoscopic cholecystectomy

If negative: Laparoscopic cholecystectomy

If negative: Laparoscopic cholecystectomy

If negative