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 it is estimated that 3.4% of patients qualified for cholecystectomy due to cholelithiasis have a coexisting choledocholithiasis . for decades , 
 endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected choledocholithiasis . 
 the method is associated with a relatively high rate of complications , including acute pancreatitis , the incidence of which is estimated to range between 0.74% and 1.86% . 
 the mechanism of this ercp - induced complication is not fully understood , although factors increasing the risk of acute pancreatitis , such as sphincter of oddi dysfunction , previous acute pancreatitis , narrow bile ducts or difficult catheterization of vater 's ampulla are known . 
 it has been suggested to discontinue the diagnostic endoscopic retrograde ascending cholangiopancreatography and replace it with endoscopic ultrasonography due to possible and potentially dangerous complications . 
 endoscopic ultrasonography has sensitivity of 94% and specificity of 95% regardless of gallstone diameter , as opposed to magnetic resonance cholangiography . 
 however , both of these parameters depend on the experience of the performing physician . 
 the use of endoscopic ultrasonography allows to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3 . ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the vater 's ampulla followed by a mechanical evacuation of stone deposits from the ducts still remains a golden standard in the treatment of choledocholithiasis . despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography , 
 the diagnostic endoscopic ultrasonography followed by a simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis . 
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