ERCP vs. Observation for Incidental Bile Duct Stones

When bile duct stones are discovered incidentally in older adults, the choice between endoscopic retrograde cholangiopancreatography (ERCP) and observation is often unclear (Figure 1). Comparative data are limited, and U.S. guidelines do not address this topic. In this retrospective study using a large U.S. database, researchers identified patients >75 years of age with asymptomatic bile duct stones. They compared outcomes between 3000 patients who underwent ERCP within 3 to 60 days of diagnosis and 3000 matched patients who did not; patients who underwent ERCP within the first few days were excluded to avoid including those with emergent indications.