Current treatment strategy for asymptomatic bile duct stones.

INTRODUCTION: Asymptomatic bile duct stones are increasingly diagnosed by imaging studies. Guidelines recommend endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of bile duct stones, but evidence regarding short- and long-term outcomes of asymptomatic bile duct stones remains inadequate. AREA COVERED: This review summarized evidence about clinical outcomes and technical tips of ERCP for asymptomatic bile duct stones through a literature search of PubMed until March 2025. Long-term outcomes including cholangitis, cholecystitis, biliary pancreatitis, and spontaneous passage of bile duct stones among patients who selected the wait-and-see strategy were also summarized. According to the recent evidence of short- and long-term outcomes, we discussed the pros and cons of each treatment option and proposed a treatment strategy for asymptomatic bile duct stones. EXPERT OPINION: Despite guideline recommendations for endoscopic removal, ERCP for asymptomatic bile duct stones is associated with a high incidence of post-ERCP pancreatitis (PEP) and clinicians need to mitigate the risk of PEP by including administration of non-steroidal anti-inflammatory drugs, prophylactic pancreatic stent, or peri-procedural aggressive hydration. Considering the probability of spontaneous stone passage, the wait-and-see strategy might be a treatment option.