Lone SA, Vaithiyam V, Vora K, Sirohi N, Sonika U, Dalal A, Kumar A, Srivastava S, Sachdeva S, Sharma BC. Predictors of incomplete common bile duct stone clearance at index endoscopic retrograde cholangiopancreatography. World J Gastrointest Endosc 2026; 18(5): 118389 [DOI: 10.4253/wjge.v18.i5.118389]
Corresponding Author of This Article
Venkatesh Vaithiyam, DM, MD, Assistant Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, JLN Marg, New Delhi 110002, Delhi, India. venkateshvaithiyam172@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
May 16, 2026 (publication date) through May 12, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lone SA, Vaithiyam V, Vora K, Sirohi N, Sonika U, Dalal A, Kumar A, Srivastava S, Sachdeva S, Sharma BC. Predictors of incomplete common bile duct stone clearance at index endoscopic retrograde cholangiopancreatography. World J Gastrointest Endosc 2026; 18(5): 118389 [DOI: 10.4253/wjge.v18.i5.118389]
Shabir A Lone, Venkatesh Vaithiyam, Keval Vora, Nikhil Sirohi, Ujjwal Sonika, Ashok Dalal, Ajay Kumar, Siddharth Srivastava, Sanjeev Sachdeva, Barjesh C Sharma, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, Delhi, India
Author contributions: Lone SA and Vaithiyam V wrote the original draft; Vaithiyam V, Sonika U and Sanjeev S contributed to conceptualization, writing, reviewing, and editing; Vora K, Sirohi N, and Dalal A participated in drafting the manuscript; Vaithiyam V, Srivastava S, Sharma CB, Ajay K, and Sanjeev S performed the final review of the manuscript and all authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of MAMC, approval No. F.1/IEC/MAMC/117/05/2025/No. 493.
Informed consent statement: The Institutional Ethics Committee approved the study protocol and granted a waiver of written informed consent due to its retrospective design and use of anonymized data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data related to the study are available from the corresponding author in the Department of Gastroenterology at Govind Ballabh Pant Institute of Postgraduate Medical Education and Research. It will be provided upon reasonable request.
Corresponding author: Venkatesh Vaithiyam, DM, MD, Assistant Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, JLN Marg, New Delhi 110002, Delhi, India. venkateshvaithiyam172@gmail.com
Received: December 31, 2025 Revised: February 4, 2026 Accepted: March 10, 2026 Published online: May 16, 2026 Processing time: 132 Days and 14.3 Hours
Abstract
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for common bile duct (CBD) stones. However, a substantial proportion of patients fail to achieve clearance during the index procedure. Identifying predictors of incomplete clearance may improve procedural planning and outcomes.
AIM
To identify the clinical, radiological, and cholangiographic predictors of incomplete CBD stone clearance during the index ERCP.
METHODS
This single-center retrospective study analyzed consecutive patients who underwent ERCP for clearance of CBD stones at a tertiary care center in New Delhi between January 2023 and October 2023. Univariate and multivariate analyses were performed to identify predictors of incomplete CBD stone clearance. Receiver operating characteristic curve analysis was used to determine the optimal magnetic resonance cholangiopancreatography-and ERCP-based predictors of incomplete CBD stone clearance.
RESULTS
A total of 245 patients (mean age 46.2 ± 14.8 years; 75.5% women) were included in the study. Complete clearance of CBD stones was achieved in 179 patients (73.1%) at the index ERCP. Multivariate analysis revealed that independent predictors of incomplete CBD stone clearance on ERCP included proximal CBD stone location [odds ratio (OR) 4.44, P = 0.003], stone-to-CBD diameter ratio > 1 (OR = 5.22, P = 0.033), presence of a CBD stricture (OR = 5.06, P = 0.049), and impacted stones (OR = 9.33, P = 0.003). Receiver operating characteristic curve analysis demonstrated that stone size (area under the curve: 0.750) and stone-to-CBD diameter ratio (area under the curve: 0.709) on ERCP were the strongest predictors of incomplete CBD stone clearance.
CONCLUSION
Proximal CBD stones, stone-to-duct size mismatch, CBD strictures, and impacted stones were predictors of incomplete CBD stone clearance, highlighting the need for careful planning and the use of advanced endoscopic techniques or surgery.
Core Tip: This retrospective study assessed clinical, radiological, and cholangiographic predictors of common bile duct (CBD) stone clearance during index endoscopic retrograde cholangiopancreatography (ERCP). Impacted stones, proximal stone location, CBD stricture, and a stone-to-CBD diameter ratio > 1 on ERCP independently predicted failure to achieve complete CBD stone clearance. A stone size of ≤ 11 mm on ERCP was identified as the optimal threshold for predicting successful clearance without the need for advanced techniques. Early identification of these predictors can assist in procedural planning, facilitate the timely use of advanced techniques or surgery, and avoid repeat ERCPs.
