Ultrasound Surveillance for Cholelithiasis

Indications for Repeat Ultrasound

Repeat imaging should only be performed if new symptoms develop (right upper quadrant pain, jaundice, fever) that warrant reassessment, as recommended by the European Society of Gastrointestinal Endoscopy 1, 2

Do not repeat transabdominal ultrasound if initial study is negative but clinical suspicion for CBD stones remains high; instead, proceed directly to MRCP or endoscopic ultrasound for intermediate-risk patients, or ERCP for high-risk patients based on risk stratification, as suggested by the European Society of Gastrointestinal Endoscopy 1, 2, 3
Risk stratification should be based on: visualization of CBD stone on initial ultrasound, CBD dilation >6mm, bilirubin >4 mg/dL, and abnormal liver enzymes, age >55, or gallstone pancreatitis, according to the American College of Gastroenterology 4

Do not repeat ultrasound to "rule out" CBD stones when initial ultrasound is negative—transabdominal ultrasound has only 73% sensitivity for CBD stones, as reported by the European Society of Gastrointestinal Endoscopy 1
Avoid repeating ultrasound in the acute setting when acute cholecystitis is suspected but initial ultrasound is equivocal; proceed to hepatobiliary scintigraphy (HIDA scan) which has 97% sensitivity, as recommended by the Infectious Diseases Society of America 5, 6