Post#3 »
Currently, in a patient with RUQ pain that sounds like a gallbladder problem, I start with gallbladder ultrasound. If it shows stones, I recommend chole.
If normal gallbladder sonogram and pain persists, I get a hepatobiliary scan with CCK (gallbladder emptying fraction). If poor gallbladder emptying, I recommend chole.
If normal gallbladder emptying and patient wants to pursue diagnosis further, I do UGI endoscopy with CCK and collect bile for crystals. This lets me look at distal esophagus, stomach and duodenum and be sure the problem isn't reflux or ulcers. If the bile contains crystals, I recommend chole with caveat that it will help about 50%.