We read with great interest the recent consensus by Zorniak et al , 1 which provides a long-awaited standardised definition of biliary sludge and microlithiasis. 30 internationally recognised experts participated in a structured survey and voting process, leading to proposed definitions: microlithiasis as 'hyperechoic calculi≤5 mm with acoustic shadowing', biliary sludge as 'hyperechoic material without acoustic shadowing, sedimenting in the dependent part of the gallbladder' and biliary stones as 'calculi>5 mm with acoustic shadowing'.
This represents an important step towards harmonising terminology and enabling future clinical studies. In routine endoscopic ultrasound (EUS) practice, however, we frequently encounter a distinct echogenic pattern not encompassed by the current definitions: floating hyperechoic particles without acoustic shadowing, eventually accentuated by abdominal compression.
This finding differs from both amorphous sludge sedimenting in the gallbladder and from microlithiasis, as defined by the consensus. It has often been observed in asymptomatic or oligosymptomatic patients undergoing elective EUS and...
Gut (BMJ) published a clinical update in Research Highlights on 06 Mar 2026.
The item focuses on Biliary sludge and microlithiasis: are we covering the full spectrum of lithogenic biliary disorders?.
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