A 42-year-old woman presents with abdominal pain for the last 2 days. She describes the pain as crampy and intermittent in the epigastric area, and she tells you that it is particularly worse after meals. She has a history of Roux-en-Y gastric bypass surgery that occurred 2 years ago.
Upon physical examination, she is afebrile. Her abdomen is soft and nontender with no masses.
Laboratory studies are shown below in the Table.
Laboratory study | Value | Normal range |
WBC count | 7,700/µL | 3,200-9,800/µL |
Hemoglobin | 13.2 g/dL | 11-14 g/dL |
Platelets | 215,000/µL | 150,000-450,00/µL |
Albumin | 4.3 g/dL | 3.5-5.5 g/dL |
AST | 334 U/L | 5-52 U/L |
ALT | 282 U/L | 7-46 U/L |
Alkaline phosphatase | 115 U/L | 40-100 U/L |
Total bilirubin | 1.7 mg/dL | 0.2-1.5 mg/dL |
Amylase | 42 U/L | 30-110 U/L |
Lipase | 24 U/L | 13-141 U/L |
ALT, alanine transaminase; AST aspartate aminotransferase; WBC, white blood cell.
Ultrasonography of the abdomen demonstrates a normal-appearing liver, mild distension of the gallbladder with several stones in the fundus of the gallbladder, and no apparent wall thickening or pericholecystic fluid. The common bile duct is dilated to 1.3 cm.
What is the next most appropriate step in the management of this patient's condition?
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