Elevated bili Mrcp neg now what?

[europeman]

Surgeon here

I have a 30 year old patient with elevated bilis (6 and 4conj) Alk Phos 3-400s, and small stones packing the gallbladder. Ultrasound shows 1cm cbd. Mrcp shows no stones in cbd and duct about 7mm.

GI refusing to ercp because of the
Mrcp.


I'm at VA where we don't have intraop choledocoscopes or an ability to explore cbd without opening.

His bilis are not dropping or period of a week.

Should I bite the bullet and operate?

I reallly order them to do the ercp preop rather than post given these findings.

What do u think?

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[europeman]

He's ruled out for other causes of bili

 

[Gastrapathy]

.