Response to ‘Biliary sludge and microlithiasis: are we covering the full spectrum of lithogenic biliary disorders?’

Abstract

We thank Mendonça Proença et al 1 for their thoughtful and constructive comments on our recently proposed consensus definition of biliary sludge and microlithiasis.2 We fully agree that only a globally standardised definition of sludge and microlithiasis will allow for high-quality prospective studies, thereby clarifying their pathophysiological relevance for both the development and recurrence of acute pancreatitis. The fourth category of biliary dust proposed by the authors, in addition to sludge, microlithiasis and gallstones, is intriguing but, in our view, not meaningful for several reasons. Not least, the PICUS-1 study demonstrated that diagnostic endoscopic ultrasound (EUS) is the first-line …