Disease-specific outcomes assessment for common bile duct stones

Clinicians often manage patients with suspected bile duct stones. Research has focused on assessing the accuracy of diagnostic alternatives to endoscopic retrograde cholangiography or on establishing predictors for stones. Studies using costs and quality of life as primary outcomes are rare. This may be caused in part by specific challenges inherent to outcomes research in the field of gastrointestinal endoscopy. It is unlikely that one strategy will be suitable for all; however, once a primary outcome is chosen, knowing what variables most affect this outcome should help clinicians objectively tailor the optimal strategy for their needs. The most important variable may be the risk of symptoms caused by untreated stones. There may be a substantial group of patients who are best managed expectantly (with no bile duct imaging). It may therefore, be useful to obtain better prospective data on the natural history of choledocholithiasis.