When to wait and when to intervene: A retrospective study on predicting spontaneous clearance of common bile duct stones in ERCP candidates.
- 1Department of Internal Medicine, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
- 2Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Abstract
Background
While ERCP is a cornerstone in the management of choledocholithiasis, a significant proportion of common bile duct (CBD) stones may clear spontaneously, prompting the need for better risk stratification. To identify independent clinical, biochemical, and radiologic predictors of spontaneous CBD stone clearance in patients referred for ERCP.Methods
In this retrospective study, 324 patients with suspected choledocholithiasis were evaluated. Demographics, symptoms, laboratory values, imaging findings, and ERCP outcomes were analyzed. Multivariable logistic regression was employed to identify predictors of spontaneous stone passage, defined as the absence of CBD stones during ERCP despite prior radiologic or biochemical suspicion.Results
Spontaneous clearance occurred in 41.4% of patients. Multivariate analysis revealed that male sex (OR = 2.1; 95% CI: 1.3-3.4), CBD diameter ≥7 mm (OR = 2.9; 95% CI: 1.7-5.0), and normalization of liver enzymes prior to ERCP (OR = 1.8; 95% CI: 1.1-3.0) were significant independent predictors. Stone size, number, and comorbidities were not statistically significant in predicting clearance.Conclusion
A combination of male sex, CBD dilation, and biochemical normalization strongly predicts spontaneous CBD stone clearance. Incorporating these variables into clinical decision-making may help avoid unnecessary ERCPs, reducing patient risk and enhancing procedural efficiency. Prospective validation of these predictors is warranted to develop evidence-based risk models.
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BibTeX
@article{hamidian2026when,
title = {{When to wait and when to intervene: A retrospective study on predicting spontaneous clearance of common bile duct stones in ERCP candidates.}},
author = {Mohammad Taghi Hamidian and Javad Shokry Shirvany and Maede Rajabi Fomashi and Ali Bijani and Seyed Hassan Abedi Valoukolaei},
journal = {Caspian journal of internal medicine},
year = {2026},
month = sep,
doi = {10.22088/cjim.17.3.555},
url = {https://europepmc.org/article/MED/42923643},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - When to wait and when to intervene: A retrospective study on predicting spontaneous clearance of common bile duct stones in ERCP candidates.
AU - Mohammad Taghi Hamidian
AU - Javad Shokry Shirvany
AU - Maede Rajabi Fomashi
AU - Ali Bijani
AU - Seyed Hassan Abedi Valoukolaei
PY - 2026
DA - 2026/09/01
JO - Caspian journal of internal medicine
DO - 10.22088/cjim.17.3.555
UR - https://europepmc.org/article/MED/42923643
AB - Background While ERCP is a cornerstone in the management of choledocholithiasis, a significant proportion of common bile duct (CBD) stones may clear spontaneously, prompting the need for better risk stratification. To identify independent clinical, biochemical, and radiologic predictors of spontaneous CBD stone clearance in patients referred for ERCP.Methods In this retrospective study, 324 patients with suspected choledocholithiasis were evaluated. Demographics, symptoms, laboratory values, imaging findings, and ERCP outcomes were analyzed. Multivariable logistic regression was employed to identify predictors of spontaneous stone passage, defined as the absence of CBD stones during ERCP despite prior radiologic or biochemical suspicion.Results Spontaneous clearance occurred in 41.4% of patients. Multivariate analysis revealed that male sex (OR = 2.1; 95% CI: 1.3-3.4), CBD diameter ≥7 mm (OR = 2.9; 95% CI: 1.7-5.0), and normalization of liver enzymes prior to ERCP (OR = 1.8; 95% CI: 1.1-3.0) were significant independent predictors. Stone size, number, and comorbidities were not statistically significant in predicting clearance.Conclusion A combination of male sex, CBD dilation, and biochemical normalization strongly predicts spontaneous CBD stone clearance. Incorporating these variables into clinical decision-making may help avoid unnecessary ERCPs, reducing patient risk and enhancing procedural efficiency. Prospective validation of these predictors is warranted to develop evidence-based risk models.
SN - 2008-6164
SN - 2008-6172
ER -