2064557 Natural History And Clinical Significance Of Isolated Biliary Sludge Diagnosed At Outpatient Sonography

Gallbladder sludge is a not uncommon diagnosis on routine abdominal ultrasound examinations in ICU or chronically ill inpatients, yet its clinical significance in the outpatient setting is uncertain. We examined an ambulatory, oupatient population to determine its natural history and subsequent complications. We conducted a retrospective search of our Institutional clinical database for all ultrasound reports using the keywords “biliary sludge” and “no gallstones” from March 2011 to February 2014. We then reviewed electronic medical records, including all subsequent imaging for each patient to evaluate for any biliary complications following the sonographic diagnosis of biliary sludge. Of the 104 patients reviewed, 27 developed a biliary complication including; cholelithiasis, cholecystitis, choledocholithiasis and pancreatitis. The most frequent developing complication was cholecystitis: 12 chronic and 2 acute cases, with 12 being acalculous. A total of 8 patients developed gallstones and 2 developed concomittant cholecystitis. An additional 4 patients without gallstones developed pancreatitis. Of those without complications, 83% had resolution of biliary sludge. Biliary sludge frequently resolved spontaneously in those with follow up imaging and no biliary related complications. However, 26% of outpatients with isolated gallbladder sludge developed cholelithiasis or inflammation of the pancreatico-biliary structures. This result implies a stepwise development of sludge to microlithiasis and gallstones, leading to cholecystitis or pancreatitis. Gallbladder sludge may act as a chronic mucosal irritant or reflect overall biliary dysfunction.Tabled 1Biliary & Pancreatic ComplicationsComplicationn (%)Average Days to DiagnosisCholelithiasis8 (7.7)341Cholecystitis14 (13.4)93Choledocholithiasis1 (1)8Pancreatitis4 (3.8)204All Complications27 (26)116 Open table in a new tab