Gallstone disease other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]


Bile microscopy has been largely replaced by transabdominal ultrasound, however it may be helpful in evaluating obese patients. Other tests may be indicated depending upon the patient's symptoms and history to rule out other differential diagnoses.

Other Imaging Findings

Bile microscopy

  • Patients who exhibit symptoms of biliary colic and ultrasound fails to detect stones often turn to microscopic analysis of their bile as proof of microlithiasis.[1][2][3][4]
  • It has an overall sensitivity of 65 - 90% for identifying patients with gallstones.
  • The test detects traces of cholesterol crystals or bilirubinate granules.
  • A high number of patients whom had clear ultrasounds had positive results on microscopy, however, the high sensitivity of tranabdominal ultrasonography has made the need for microscopy rare.

Other Tests


  1. Delchier JC, Benfredj P, Preaux AM, Metreau JM, Dhumeaux D (1986). "The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation". Hepatology. 6 (1): 118–22. PMID 3943777.
  2. Moskovitz M, Min TC, Gavaler JS (1986). "The microscopic examination of bile in patients with biliary pain and negative imaging tests". Am. J. Gastroenterol. 81 (5): 329–33. PMID 3706246.
  3. Sedaghat A, Grundy SM (1980). "Cholesterol crystals and the formation of cholesterol gallstones". N. Engl. J. Med. 302 (23): 1274–7. doi:10.1056/NEJM198006053022302. PMID 7366692.
  4. Gollish SH, Burnstein MJ, Ilson RG, Petrunka CN, Strasberg SM (1983). "Nucleation of cholesterol monohydrate crystals from hepatic and gall-bladder bile of patients with cholesterol gall stones". Gut. 24 (9): 836–44. PMC 1420078. PMID 6884818.
  5. Shaffer EA (2005). "Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?". Curr Gastroenterol Rep. 7 (2): 132–40. PMID 15802102.
  6. Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D (2016). "Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors". Surg Endosc. 30 (10): 4539–43. doi:10.1007/s00464-016-4790-4. PMID 26895902.

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