en Gastroentrology Gastroentrology Original Article Original Article <span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:14pt"><b><i><span style="color:blue">Background</span></i></b><i><span style="color:blue">:</span></i> 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. </span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Methods:</span></i></b> 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.</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Results:</span></i></b> Spontaneous clearance occurred in 41.4% of patients. Multivariate analysis revealed that male sex (OR = 2.1; 95% CI: 1.3&ndash;3.4), CBD diameter &ge;7 mm (OR = 2.9; 95% CI: 1.7&ndash;5.0), and normalization of liver enzymes prior to ERCP (OR = 1.8; 95% CI: 1.1&ndash;3.0) were significant independent predictors. Stone size, number, and comorbidities were not statistically significant in predicting clearance.</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Conclusion</span></i></b><i><span style="color:blue">:</span></i> 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.</span></span></span><br> &nbsp; ERCP, choledocholithiasis, common bile duct stones, spontaneous stone clearance, CBD dilation, liver enzymes, MRCP, hepatobiliary imaging 555 561 http://caspjim.com/browse.php?a_code=A-10-3822-1&slc_lang=en&sid=1 Meysam Hamidian mt.hamidian@mubabol.ac.ir 100319475328460057797 100319475328460057797 No Department of Internal Medicine, Rohani Hospital, Babol University of Medical Sciences, Babol, Mazandaran, Iran Javad Shokryshirvany javadshokry@gmail.com 100319475328460057798 100319475328460057798 Yes Department of Internal Medicine, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran Maede Rajabi Fomashi maederajabi@yahoo.com 100319475328460057799 100319475328460057799 No Department of Internal Medicine, Rohani Hospital, Babol University of Medical Sciences, Babol, Mazandaran, Iran Ali Bijani 100319475328460057800 100319475328460057800 No Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Seyed Hassan Abedi Valoukolaei 100319475328460057801 100319475328460057801 No Department of Internal Medicine, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran