Graziano GM, Di Mattia P, Centonze DC. Management of common bile duct stones in the absence of endoscopic retrograde cholangiopancreatography. World J Gastrointest Surg 2026; 18(7): 121450 [DOI: 10.4240/wjgs.v18.i7.121450]
Corresponding Author of This Article
Giorgio MP Graziano, Assistant Professor, Medicine and Surgery, Università degli studi di Enna “KORE”, Piazza dell'Università, Enna 94100, Sicilia, Italy. giorgio.graziano@unikore.it
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Surgery
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Graziano GM, Di Mattia P, Centonze DC. Management of common bile duct stones in the absence of endoscopic retrograde cholangiopancreatography. World J Gastrointest Surg 2026; 18(7): 121450 [DOI: 10.4240/wjgs.v18.i7.121450]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 121450 Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.121450
Management of common bile duct stones in the absence of endoscopic retrograde cholangiopancreatography
Giorgio MP Graziano, Paolo Di Mattia, Danilo C Centonze
Giorgio MP Graziano, Paolo Di Mattia, Medicine and Surgery, Università degli studi di Enna “KORE”, Enna 94100, Sicilia, Italy
Danilo C Centonze, Department of Surgery, General Surgery Unit, ASP Enna, Enna 94100, Sicilia, Italy
Author contributions: Graziano GMP designed the study; Graziano GMP and Centonze DC performed the research; Graziano GMP and Di Mattia P drafted the manuscript. All authors contributed to manuscript revision and approved the final version.
AI contribution statement: No artificial intelligence tools were used to generate the scientific content of this manuscript. AI-based tools (such as language editing or writing assistance tools) may have been used to improve the clarity and readability of the text; however, all content was critically reviewed, edited, and approved by the authors. No AI tools were involved in study design, data interpretation, or generation of figures.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Giorgio MP Graziano, Assistant Professor, Medicine and Surgery, Università degli studi di Enna “KORE”, Piazza dell'Università, Enna 94100, Sicilia, Italy. giorgio.graziano@unikore.it
Received: March 25, 2026 Revised: April 13, 2026 Accepted: May 13, 2026 Published online: July 27, 2026 Processing time: 124 Days and 20.8 Hours
Abstract
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of common bile duct (CBD) stones; however, it is not universally available. In hospitals lacking on-site ERCP, alternative diagnostic and therapeutic strategies are required, but the scope and quality of the supporting evidence remain unclear.
AIM
To map and synthesize the available literature on non-ERCP diagnostic and therapeutic strategies for CBD stones.
METHODS
A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. PubMed/MEDLINE and Scopus were searched for studies published between 2020 and 2025 on non-ERCP strategies for CBD stones. Eligible studies included observational and comparative designs. Data were extracted and analyzed descriptively, focusing on diagnostic modalities, surgical strategies, and reported outcomes.
RESULTS
Seven studies met the inclusion criteria, predominantly retrospective and single-center in design. Magnetic resonance cholangiopancreatography, endoscopic ultrasound, and intraoperative imaging were the most frequently reported diagnostic modalities. Laparoscopic CBD exploration, using transcystic or transductal approaches, was the main therapeutic strategy. Outcomes varied across studies and were closely related to institutional expertise and resource availability.
CONCLUSION
The available evidence is limited and heterogeneous. Non-ERCP strategies are feasible in selected settings, but current data do not support broad generalization.
Core Tip: Endoscopic retrograde cholangiopancreatography (ERCP) is not universally available, necessitating alternative strategies for common bile duct stone management. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews scoping review maps the limited and heterogeneous evidence on non-ERCP diagnostic and surgical approaches. Current data are largely retrospective and derived from specialized centers, underscoring the context-dependent feasibility of these strategies and the need for prospective multicenter validation.
