How to investigate cholestasis: utility of ultrasound as the first imaging study.

In modern gastroenterology, ultrasonography, particularly the real-time modality, is one of the most important diagnostic procedures, and the value of ultrasound in the diagnosis of cholestasis, and obstructive jaundice in particular, is indisputable. Although sector-type real-time ultrasonography has certain merits, for a routine examination, the linear scan is much more practical. It should be the first imaging investigation in patients with jaundice, along with the routine hematologic and biochemical tests. In obstructive jaundice, these studies are followed by ERC or PTC, and a definitive diagnosis is possible in the large majority of patients. Such a diagnosis very rarely requires correction at surgery.