Caspian Journal of Internal Medicine
Babol University of Medical Sciences
Sun, Sep 6, 2026
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Volume 17, Issue 3 (Summer 2026)
Caspian J Intern Med 2026, 17(3): 555-561 |
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Ethics code: IR.MUBABOL.REC.1401.095
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Hamidian M, Shokryshirvany J, Rajabi Fomashi M, Bijani A, Abedi Valoukolaei S H. When to wait and when to intervene: A retrospective study on predicting spontaneous clearance of common bile duct stones in ERCP candidates. Caspian J Intern Med 2026; 17 (3) :555-561
URL: http://caspjim.com/article-1-4838-en.html
URL: http://caspjim.com/article-1-4838-en.html
Meysam Hamidian 
, Javad Shokryshirvany * , Maede Rajabi Fomashi , Ali Bijani , Seyed Hassan Abedi Valoukolaei
, Javad Shokryshirvany * , Maede Rajabi Fomashi , Ali Bijani , Seyed Hassan Abedi Valoukolaei
Department of Internal Medicine, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran , javadshokry@gmail.com
Abstract: (9 Views)
Background: While ERCP is a cornerstone in the management of choledocholithiasis, a significant proportion of common bile duct (CBD) stones may clear spontaneously, prompting the need for better risk stratification. To identify independent clinical, biochemical, and radiologic predictors of spontaneous CBD stone clearance in patients referred for ERCP.
Methods: In this retrospective study, 324 patients with suspected choledocholithiasis were evaluated. Demographics, symptoms, laboratory values, imaging findings, and ERCP outcomes were analyzed. Multivariable logistic regression was employed to identify predictors of spontaneous stone passage, defined as the absence of CBD stones during ERCP despite prior radiologic or biochemical suspicion.
Results: Spontaneous clearance occurred in 41.4% of patients. Multivariate analysis revealed that male sex (OR = 2.1; 95% CI: 1.3–3.4), CBD diameter ≥7 mm (OR = 2.9; 95% CI: 1.7–5.0), and normalization of liver enzymes prior to ERCP (OR = 1.8; 95% CI: 1.1–3.0) were significant independent predictors. Stone size, number, and comorbidities were not statistically significant in predicting clearance.
Conclusion: A combination of male sex, CBD dilation, and biochemical normalization strongly predicts spontaneous CBD stone clearance. Incorporating these variables into clinical decision-making may help avoid unnecessary ERCPs, reducing patient risk and enhancing procedural efficiency. Prospective validation of these predictors is warranted to develop evidence-based risk models.
Methods: In this retrospective study, 324 patients with suspected choledocholithiasis were evaluated. Demographics, symptoms, laboratory values, imaging findings, and ERCP outcomes were analyzed. Multivariable logistic regression was employed to identify predictors of spontaneous stone passage, defined as the absence of CBD stones during ERCP despite prior radiologic or biochemical suspicion.
Results: Spontaneous clearance occurred in 41.4% of patients. Multivariate analysis revealed that male sex (OR = 2.1; 95% CI: 1.3–3.4), CBD diameter ≥7 mm (OR = 2.9; 95% CI: 1.7–5.0), and normalization of liver enzymes prior to ERCP (OR = 1.8; 95% CI: 1.1–3.0) were significant independent predictors. Stone size, number, and comorbidities were not statistically significant in predicting clearance.
Conclusion: A combination of male sex, CBD dilation, and biochemical normalization strongly predicts spontaneous CBD stone clearance. Incorporating these variables into clinical decision-making may help avoid unnecessary ERCPs, reducing patient risk and enhancing procedural efficiency. Prospective validation of these predictors is warranted to develop evidence-based risk models.
Keywords: ERCP, choledocholithiasis, common bile duct stones, spontaneous stone clearance, CBD dilation, liver enzymes, MRCP, hepatobiliary imaging
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Subject:
Gastroentrology
Received: 2025/07/18 | Accepted: 2025/10/27 | Published: 2026/06/9
Received: 2025/07/18 | Accepted: 2025/10/27 | Published: 2026/06/9
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