Diagnosis of Gallstones

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Most cases of gallstones are uncovered by chance during investigation of an unrelated condition. Their presence can be detected by the testing of blood and cholesterol, by x-ray in around 10% of cases, or by ultrasound scanning in 95% of cases. The presence of stones, however, is not in itself a reason for concern or for treatment. Gallstones need treatment only when they cause trouble.

More detailed information about gallstones and the state of the gall bladder can be obtained by a method called cholangiography. This is an x-ray of the bile ducts, taken after introducing a radiopaque contrast fluid that is visible on x-rays. The fluid can be injected into the bloodstream so that it concentrates in the bile ducts and gall bladder, or it may be inserted up into the bile duct from the intestine by way of a flexible fibre optic camera (endoscope).

The procedure to achieve this is called endoscopic retrograde cholangiopancreatolography (ERCP). Its main object is to show stones in the bile ducts and gall bladder. Using an endoscope, a fine catheter is passed through the duodenum and into the shared entrance to the bile and pancreatic duct systems.

The dye which is opaque to x-rays is then injected and images taken. These will reveal any abnormality in the bile or pancreatic systems, such as gallstones, bile duct disorders, Pancreatitis or cancer of the head of the pancreas. The duct from the pancreas enters the duodenum at the same point as the bile duct.