Management of Common Bile Duct Stones: Current Approaches and Evolving Endoscopic Strategies

This review evaluates the evolving management strategies for common bile duct stones (CBDSs), focusing on standard endoscopic techniques, advanced intraductal interventions for refractory stones, and contemporary minimally invasive surgical options.

While endoscopic retrograde cholangiopancreatography with sphincterotomy remains the cornerstone of therapy, recent evidence highlights the efficacy and safety of endoscopic papillary large balloon dilation and single-operator cholangioscopy-guided lithotripsy for difficult and refractory stones. Concurrently, laparoscopic common bile duct exploration has proven effective as a single-stage definitive treatment, demonstrating safety and stone clearance outcomes equivalent to the traditional two-stage endoscopic-surgical approach. The management of CBDSs has shifted from a rigid, standardized protocol to a highly tailored clinical algorithm. No single gold-standard strategy is applicable to every scenario. Optimal outcomes are achieved through a flexible, multidisciplinary approach that customizes intervention based on stone characteristics, patient anatomy, and available institutional expertise.