Comparison of MRCP/ERCP and EUS for the detection of common bile duct stones

Small bile duct stone missed by magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), but shown by endoscopic ultrasound (EUS). This demonstrates the superior sensitivity of EUS for small bile duct stones. A) MRCP showing dilated bile duct with no apparent stone, incidental pancreas divisum. B) EUS in same patient showing very small bile duct stone (<5 mm) (arrow). C) ERCP in same patient showing dilated common bile duct without apparent stone. D) Endoscopic view of extracted stone after biliary sphincterotomy (arrow).