Endoscopic retrograde cholangiopancreatography. Diagnosis of cholelithiasis in patients with normal gallbladder x-ray and ultrasound studies.

The combination of a normal oral cholecystogram and ultrasound study of the gallbladder is considered adequate evidence to exclude cholelithiasis as a cause of biliarylike pain. We examined 206 patients with biliarylike pain and normal findings on cholecystogram and ultrasound study of the gallbladder by endoscopic retrograde cholangiopancreatography (ERCP). Of the 195 patients who had successful ERCP, 32 patients (group 1) had mild, transient abnormalities in liver function tests and 163 (group 2) had normal liver function test results. Small gallstones were demonstrated on ERCP examination in 25 of 32 group 1 patients and in four of 163 group 2 patients, all confirmed at surgery or endoscopic sphincterotomy. In conclusion, despite negative results on cholecystogram and ultrasound study of the gallbladder, patients with biliarylike pain and abnormal liver function test results should be evaluated further by diagnostic ERCP examination.