MRCP and EUS are diagnostically equivalent in detecting CBD stones among patients with intermediate risk, as shown in a landmark RCT. However, MRI-based imaging is power-intensive, requiring large infrastructure and long scan durations. EUS, a less energy-consuming and portable procedure, has the added advantage of enabling same-session ERCP, reducing the need for repeat procedures.

MRCP and EUS are diagnostically equivalent in detecting CBD stones among patients with intermediate risk, as shown in a landmark RCT. However, MRI-based imaging is power-intensive, requiring large infrastructure and long scan durations. EUS, a less energy-consuming and portable procedure, has the added advantage of enabling same-session ERCP, reducing the need for repeat procedures. Prior research confirms that diagnostic EUS generates significantly less CO₂e per procedure compared to radiologic imaging. This study aims to support sustainable diagnostic choices by quantifying their environmental footprint.

Inclusion Criteria:

• Age ≥18 years
• Intermediate likelihood of CBD stone (per ESGE)
• Undergoing either MRCP or EUS for evaluation

Exclusion Criteria:

• High or low likelihood category (per ESGE)
• Undergoing both MRCP and EUS simultaneously
• Contraindications to either modality

Adult patients (>18 years - 80years) with suspected choledocholithiasis and classified as intermediate risk per ESGE guidelines, undergoing either EUS or MRCP.