Management of asymptomatic bile duct stones

Abstract

The current guidelines recommend endoscopic treatment of asymptomatic bile duct stones with ERCP. However, the natural history of asymptomatic bile duct stones remains unclear, and the appropriateness of aggressive endoscopic treatment of asymptomatic bile duct stones remains to be discussed. The risk of ERCP-related complications, especially post-ERCP pancreatitis, may be higher in asymptomatic patients with bile duct stones than in symptomatic patients. There is no prospective study to investigate whether ERCP is better than wait-and-see in asymptomatic patients with bile duct stones, and the risk of inducing ERCP-related complications cannot be balanced against the risk of complications in patients who are followed without treatment. To clarify the justification for aggressive treatment of asymptomatic bile duct stones, large-scale, multicenter studies should be conducted to evaluate the long-term risk of complications in the ERCP and wait-and-see groups.