Current treatment strategy for asymptomatic bile duct stones

Asymptomatic bile duct stones are increasingly diagnosed by imaging studies. Guidelines recommend endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of bile duct stones, but evidence regarding short- and long-term outcomes of asymptomatic bile duct stones remains inadequate.

This review summarized evidence about clinical outcomes and technical tips of ERCP for asymptomatic bile duct stones through a literature search of PubMed until March 2025. Long-term outcomes including cholangitis, cholecystitis, biliary pancreatitis, and spontaneous passage of bile duct stones among patients who selected the wait-and-see strategy were also summarized. According to the recent evidence of short- and long-term outcomes, we discussed the pros and cons of each treatment option and proposed a treatment strategy for asymptomatic bile duct stones.

Despite guideline recommendations for endoscopic removal, ERCP for asymptomatic bile duct stones is associated with a high incidence of post-ERCP pancreatitis (PEP) and clinicians need to mitigate the risk of PEP by including administration of non-steroidal anti-inflammatory drugs, prophylactic pancreatic stent, or peri-procedural aggressive hydration. Considering the probability of spontaneous stone passage, the wait-and-see strategy might be a treatment option.