Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 28: I Have A Patient With Biliary-Type Pain, But No Other Evidence Of Bile Duct Disease (Normal Diameter Duct On Ultrasound, Normal Liver Function Tests). How Should Such A Patient Be Managed? (continued)

Martin L. Freeman, MD, FACG, FASGE

Right upper quadrant (RUQ) pain syndrome is most common in women, particularly those who are young to middle-aged. The first question we should ask is whether the gallbladder is intact. Our first efforts should be to thoroughly investigate whether there is any evidence of gallbladder disease. Computed tomography is generally performed to look for structural abnormalities, but it is generally negative. A high-quality RUQ ultrasound should be done. If there is any evidence of gallbladder sludge or stone disease, it is reasonable to offer laparoscopic cholecystectomy. If negative, then a…