Copyright ©The Author(s) 2021.
World J Gastroenterol. May 14, 2021; 27(18): 2131-2140
Published online May 14, 2021. doi: 10.3748/wjg.v27.i18.2131
Table 1 Recommended management and evidence level in current guidelines for asymptomatic common bile duct stones
ESGE[1]ESGE recommends stone extraction in all patients with CBDS, regardless of being symptomatic or not, who are fit enough to tolerate the intervention. (Strong recommendation, low quality evidence)
BSG[3]Stone extraction is recommended in patients diagnosed with CBDS if possible. Evidence of benefit of stone extraction is greatest for symptomatic patients (Low quality evidence; strong recommendation)
JGES[4]Asymptomatic choledocholithiasis should be treated because of a risk of developing biliary complications. [Evidence level: A; Strength of recommendation (agreement rate): 2 (100%)]
ASGE[5]CBDS should be treated if detected regardless of the presence or absence of significant mitigating clinical circumstances (Moderate quality)
Table 2 Summary of studies comparing the risks of endoscopic retrograde cholangiopancreatography-related complications for asymptomatic and symptomatic patients with common bile duct stones
Ref.Study design Patients, n
Overall, complications (%)
PEP (%)
Asymptomatic group
Symptomatic group
Asymptomatic group
Symptomatic group
Asymptomatic group
Symptomatic group
Kim et al[9], 2016Single-center retrospective3253615.610.412.5a3.9
Saito et al[10], 2017Multicenter retrospective6753626.9a3.916.4a2.2
Saito et al[11], 2019Multicenter retrospective16494919.5a6.214.6a3.0
Xu et al[12], 2019Single-center prospective5327426.4a11.720.8a6.9
Xiao et al[13], 2021Single-center retrospective7979513.
Table 3 Summary of studies reporting natural history of asymptomatic common bile duct stones
Study design
Patients, n
Median follow-up period
Cumulative incidence of biliary complications, n (%)
Ammori et al[14], 2000Prospective141.4 yr4 (29)
Collins et al[15], 2004 Prospective466 wk0
Caddy et al[16], 2005Retrospective594.8 yr0
Moller et al[17], 2014Retrospective59430 d150 (25)
Hakuta et al[18], 2020Retrospective1143.2 yr20 (18)