The aim of this work is to develop a consensus position on the definitions, diagnosis, and treatment tactics of biliary sludge (BS). During expert discussions, the issues related to the diagnosis and patient management with BS were clarified; a number of relevant questions were discussed, and viewpoints were identified that warrant further expert investigation. Special attention was paid to the role of ursodeoxycholic acid (UDCA) in the treatment and prevention of BS progression, the benefit–risk ratio associated with the use of UDCA in patients with BS, as well as the evidence base supporting UDCA use for this condition. Both the classification and the diagnostic and therapeutic approaches require further refinement. Thus, BS is recognized as a clinically significant condition. The development of a unified interdisciplinary position among gastroenterologists, surgeons, ultrasound specialists, and endoscopists regarding the diagnosis and patient management with BS is necessary. In patients at high risk of BS progression (development of cholelithiasis or surgical complications), the administration of UDCA is indicated.