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DOI: 10.1055/s-0042-1745651
Consensus Definition of Biliary Microlithiasis and Sludge: Results from a systematic review of the literature, expert survey and consensus meeting
Introduction In up to 20% the etiology of acute pancreatitis (AP) remains elusive after routine work-up. Nevertheless, a biliary etiology warrants treatment to prevent recurrence. According to international guidelines EUS is recommended to exclude occult microlithiasis/biliary sludge as cause of pancreatitis. In a systematic literature review we analysed definitions of biliary sludge and microlithasis. In an expert survey we aimed for a consensus definition allowing to prospectively determine the risk of biliary pancreatitis from sludge and/or microlithiasis.
Methods Following the PRISMA guideline and derived from a systematic review of the literature an online-survey (36 questions: clinical cases, definition, treatment strategy) was developed and sent to 30 HBP and EUS experts from 11 countries and 4 continents to coin definitions agreed on by audience voting (EPC 2021).
Results The literature review demonstrated that in 13% of original articles and 19.2% of reviews, microlithiasis and biliary sludge are used as synonyms and in the survey 41.7% experts described the term “biliary sludge” and “biliary microlithiasis” as identical finding, illustrating the clinical dilemma. As result of the survey three definitions were proposed, agreed and confirmed.
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The term „biliary sludge“ can be used both to diagnose findings in the bile duct as well as the gallbladder.
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Discrete, hyperechoic material inside the gallbladder or the bile duct, without acoustic shadowing, which sediments in the most dependent part of the gallbladder represents biliary sludge.
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The term „biliary microlithiasis“ should be used exclusively for cases in which EUS examination of the biliary tree reveals presence of stones bigger than 3 and less than 5 mm (in diameter).
Summary We propose for the first time a definition of the localization, sonomorphology and size of biliary sludge as well as microlithiasis. Its relevance for risk assessment of pancreatitis and treatment recommendation needs testing in prospective studies.
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Publication History
Article published online:
29 March 2022
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