Mild gallstone pancreatitis — ESEGH MCQ

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HardPancreatico-biliary DiseaseMild gallstone pancreatitisESEGH

MRCP shows two common-bile-duct stones in a patient with gallbladder stones but no current cholangitis. Which definitive package follows NICE?

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Correct answer: D — Clear the bile duct and perform laparoscopic cholecystectomy

The best answer is “Clear the bile duct and perform laparoscopic cholecystectomy”. The duct may be cleared surgically or by ERCP before or at cholecystectomy, but both duct clearance and gallbladder treatment are required. “Observe because the duct stones are currently asymptomatic” is less appropriate because NICE recommends clearance of symptomatic or asymptomatic CBD stones “Perform ERCP alone and leave the gallbladder indefinitely” is less appropriate because duct clearance does not prevent recurrent gallbladder-source events “Give long-term antibiotics before source control” is less appropriate because antibiotics do not remove stones “Use pancreatic enzymes as definitive treatment” is less appropriate because enzymes do not clear the biliary tree

Reference: NICE CG188 gallstone disease: https://www.nice.org.uk/guidance/cg188/chapter/3-other-information