Preventing Unnecessary Endoscopic Retrograde Cholangiopancreatography in Patients With Spontaneous Bile Duct Stone Passage: A Systematic Review and Meta-Analysis

Abstract

Background: Common bile duct stones (CBDS) have the potential to pass spontaneously through the duodenal papilla. Investigating the predictors of spontaneous CBDS passage can help to prevent unnecessary endoscopic retrograde cholangiopancreatography (ERCP) and related adverse events. This meta-analysis aims to assess the incidence and predictors of spontaneous CBDS passage in patients with confirmed CBDS via imaging methods.

Methods: A systematic search was performed in PubMed, Web of Science, and Scopus up to January 2025. Point estimates and 95% confidence intervals (CIs) were calculated for each outcome using random effects models. The protocol of the study was registered in PROSPERO (CRD42025637057).

Results: Of the total 2346 screened records, nine cohorts met the inclusion criteria (3338 patients). The overall incidence of spontaneous CBDS passage was estimated at 15.7% (95% CI 11.5%, 21.2%, I² = 93.0%), and the mean size of the CBDS in patients with stone passage was 3.77 (95% CI 3.13, 4.41). Age (standardized mean difference [SMD] = -0.42; 95% CI -0.55, -0.29), CBD diameter (SMD = -0.52; 95% CI -0.75, -0.28), stone size (SMD = -0.91; 95% CI -1.13, -0.69), single CBDS (risk ratio = 1.63; 95% CI 1.51, 1.76), and time from diagnosis to ERCP (SMD = 0.39: 95% CI 0.00, 0.78) were significantly associated with spontaneous CBDS passage. However, no significant association was observed for female sex, cholangitis, and acute pancreatitis (p > 0.05).

Conclusions: A watch-and-wait approach in patients with high probability of spontaneous CBDS passage could avoid unnecessary ERCP and related adverse events in these patients. Further large-scale, prospective studies are needed to validate these findings.

Keywords: ERCP; endoscopic retrograde cholangiopancreatography; migration; stone passage.