{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:56:19Z","timestamp":1792788979696,"version":"4.5.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Handan Municipal Science and Technology Research and Development Program","award":["223422083267"],"award-info":[{"award-number":["223422083267"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>CBD stones impose significant morbidity and cost. This review compares the efficacy and safety of endoscopic sphincterotomy (EST) and laparoscopic common bile duct exploration (LCBDE) and summarizes emerging techniques and remaining controversies. While EST remains a cornerstone for rapid stone extraction, particularly in high-risk surgical candidates, its association with post-procedural pancreatitis and long-term sphincter dysfunction underscores the need for judicious patient selection. Conversely, LCBDE emerges as a compelling alternative, offering superior complete stone clearance rates for larger or complex stones, reduced post-procedural pancreatitis, and the unique advantage of direct biliary tree visualization. However, its technical demands and bile leak risk necessitate standardized training protocols and institutional expertise. The review further explores cutting-edge adjunctive therapies, including SpyGlass cholangioscopy for impacted stones, extracorporeal shock wave lithotripsy (ESWL) for large calculi, and artificial intelligence-driven procedural planning, which collectively herald a new era of precision medicine in biliary surgery. Notably, hybrid approaches such as intraoperative endoscopic retrograde cholangiopancreatography (ERCP) demonstrate promising outcomes in reducing hospitalization and postoperative complications, albeit requiring multidisciplinary team coordination. Despite these advances, critical knowledge gaps persist regarding long-term functional outcomes of EST, cost-effectiveness of emerging technologies, and optimal management of anatomically complex cases. The lack of robust randomized trials comparing EST and LCBDE in diverse patient cohorts limits contemporary guideline development, underscoring the urgent need for high-quality comparative effectiveness research. This review synthesizes current evidence to advocate for a personalized, algorithmic approach to CBD stones management, balancing procedural risks, stone characteristics, and institutional capabilities. By highlighting translational research opportunities and unmet clinical needs, it provides a roadmap for advancing minimally invasive biliary surgery while challenging the global hepatobiliary community to prioritize patient-centered innovation and rigorous outcomes research.<\/jats:p>","DOI":"10.3389\/fsurg.2025.1658784","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:31:18Z","timestamp":1762929078000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Management of common bile duct stones: a comprehensive review"],"prefix":"10.3389","volume":"12","author":[{"given":"Xiaojun","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhifeng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1308\/rcsann.2020.0109","article-title":"Cost effectiveness of intraoperative laparoscopic ultrasound for suspected choledocholithiasis; outcomes from a specialist benign upper gastrointestinal unit","volume":"102","author":"Donoghue","year":"2020","journal-title":"Ann R Coll Surg Engl"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1111\/ans.15565","article-title":"Incidence and predictors of common bile duct stones in patients with acute cholecystitis: a systematic literature review and meta-analysis","volume":"90","author":"Chen","year":"2020","journal-title":"ANZ J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e030293","DOI":"10.1136\/bmjopen-2019-030293","article-title":"Protocol for the CREST choles (Chinese REgistry study on treatment of cholecysto-choledocholithiasis) study: an ambispective, multicenter, observational, open-cohort study","volume":"9","author":"Zhu","year":"2019","journal-title":"BMJ Open"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3511","DOI":"10.4240\/wjgs.v16.i11.3511","article-title":"Laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrence-associated risk factors","volume":"16","author":"Liao","year":"2024","journal-title":"World J Gastrointest Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.gie.2023.03.023","article-title":"Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials","volume":"98","author":"Akshintala","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e21111","DOI":"10.1097\/MD.0000000000021111","article-title":"Recurrent ascending cholangitis with acute pancreatitis and pancreatic atrophy caused by a juxtapapillary duodenal diverticulum: a case report and literature review","volume":"99","author":"Alzerwi","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e29002","DOI":"10.1097\/MD.0000000000029002","article-title":"Single-stage intraoperative ERCP combined with laparoscopic cholecystectomy versus preoperative ERCP followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a meta-analysis of randomized trials","volume":"101","author":"Liao","year":"2022","journal-title":"Medicine (Baltimore)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1111\/jgh.12241","article-title":"Nutritional factors (nutritional aspects) in biliary disorders: bile acid and lipid metabolism in gallstone diseases and pancreaticobiliary maljunction","volume":"28","author":"Tazuma","year":"2013","journal-title":"J Gastroenterol Hepatol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"615","DOI":"10.17235\/reed.2020.6760\/2019","article-title":"Differences between residual and primary choledocholithiasis in cholecystectomy patients","volume":"112","author":"Ruiz Pardo","year":"2020","journal-title":"Rev Esp Enferm Dig"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e9767","DOI":"10.1097\/MD.0000000000009767","article-title":"Analysis of clinical characteristics and treatment of immunoglobulin G4-associated cholangitis: a retrospective cohort study of 39 IAC patients","volume":"97","author":"Xiao","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1007\/s10620-024-08374-0","article-title":"Comparative risks of post-ERCP adverse events in patients with asymptomatic and symptomatic choledocholithiasis: a systematic review and meta-analysis","volume":"69","author":"Obaitan","year":"2024","journal-title":"Dig Dis Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2377","DOI":"10.1007\/s00261-019-01975-8","article-title":"Diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population: a clinical effectiveness study","volume":"44","author":"Dillman","year":"2019","journal-title":"Abdom Radiol (NY)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1016\/j.gie.2017.06.009","article-title":"Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: a meta-analysis of diagnostic test accuracy in head-to-head studies","volume":"86","author":"Meeralam","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"B14","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1097\/MCG.0000000000000502","article-title":"Elevated serum bilirubin level correlates with the development of cholangiocarcinoma, subsequent liver transplantation, and death in patients with primary sclerosing cholangitis","volume":"50","author":"Haseeb","year":"2016","journal-title":"J Clin Gastroenterol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1053\/j.gastro.2014.08.029","article-title":"Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: an international follow-up study","volume":"147","author":"Lammers","year":"2014","journal-title":"Gastroenterology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1007\/s10143-020-01361-9","article-title":"A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele","volume":"44","author":"Coelho","year":"2021","journal-title":"Neurosurg Rev"},{"key":"B17","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s00068-019-01205-2","article-title":"Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history","volume":"47","author":"Karhof","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s13018-023-03824-3","article-title":"Endoscopic treatment of lumbar ligamentum flavum cyst by interlaminar approach: a minimally invasive and effective alternative to open surgery","volume":"18","author":"Tang","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"E1447","DOI":"10.1055\/a-1905-0251","article-title":"Outcomes of balloon vs basket catheter for clearance of choledocholithiasis: a systematic review and meta-analysis","volume":"10","author":"Sharma","year":"2022","journal-title":"Endosc Int Open"},{"key":"B20","first-page":"297","article-title":"Biliary stenting as alternative therapy to stone clearance in elderly patients with bile duct stones","volume":"77","author":"Horiuchi","year":"2014","journal-title":"Acta Gastroenterol Belg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1055\/s-0042-108641","article-title":"Papillary cannulation and sphincterotomy techniques at ERCP: european society of gastrointestinal endoscopy (ESGE) clinical guideline","volume":"48","author":"Testoni","year":"2016","journal-title":"Endoscopy"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1016\/j.gie.2008.10.015","article-title":"Post-ERCP pancreatitis rates do not differ between needle-knife and pull-type pancreatic sphincterotomy techniques: a multiendoscopist 13-year experience","volume":"69","author":"Lawrence","year":"2009","journal-title":"Gastrointest Endosc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s11605-009-1134-x","article-title":"Success and complication rates of two precut techniques, transpancreatic sphincterotomy and needle-knife sphincterotomy for bile duct cannulation","volume":"14","author":"Wang","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4103\/2277-9175.114186","article-title":"Endoscopic papillary balloon dilatation in comparison with endoscopic sphincterotomy for the treatment of large common bile duct stone","volume":"2","author":"Minakari","year":"2013","journal-title":"Adv Biomed Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1038\/ajg.2010.421","article-title":"Large balloon dilation vs. Mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study","volume":"106","author":"Stefanidis","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s12876-019-1017-x","article-title":"The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones","volume":"19","author":"Kuo","year":"2019","journal-title":"BMC Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"E54","DOI":"10.1055\/s-0042-118701","article-title":"Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones","volume":"5","author":"Wong","year":"2017","journal-title":"Endosc Int Open"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3092","DOI":"10.1007\/s10620-014-3259-3","article-title":"Endoscopic papillary large balloon dilation for treatment of large bile duct stones does not increase the risk of post-procedure pancreatitis","volume":"59","author":"Park","year":"2014","journal-title":"Dig Dis Sci"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1055\/s-0034-1392482","article-title":"Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study","volume":"47","author":"Langerth","year":"2015","journal-title":"Endoscopy"},{"key":"B30","doi-asserted-by":"publisher","first-page":"26","DOI":"10.4253\/wjge.v9.i1.26","article-title":"Recurrence of choledocholithiasis following endoscopic bile duct clearance: long term results and factors associated with recurrent bile duct stones","volume":"9","author":"Konstantakis","year":"2017","journal-title":"World J Gastrointest Endosc"},{"key":"B31","doi-asserted-by":"publisher","first-page":"6391","DOI":"10.3748\/wjg.v26.i41.6391","article-title":"Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques","volume":"26","author":"Barakat","year":"2020","journal-title":"World J Gastroenterol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1001\/jamasurg.2014.249","article-title":"Natural course vs interventions to clear common bile duct stones: data from the Swedish registry for gallstone surgery and endoscopic retrograde cholangiopancreatography (GallRiks)","volume":"149","author":"Moller","year":"2014","journal-title":"JAMA Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3521","DOI":"10.3892\/etm.2016.3834","article-title":"A double gallbladder with a common bile duct stone treated by laparoscopy accompanied by choledochoscopy via the cystic duct: a case report","volume":"12","author":"Yu","year":"2016","journal-title":"Exp Ther Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e24486","DOI":"10.1097\/MD.0000000000024486","article-title":"Percutaneous removal of common bile duct stones using a modified balloon technique","volume":"100","author":"Kim","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"B35","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1001\/jamapediatrics.2019.6242","article-title":"Association of childhood asthma with federal rental assistance","volume":"174","author":"Boudreaux","year":"2020","journal-title":"JAMA Pediatr"},{"key":"B36","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/MCG.0000000000002009","article-title":"Comparison of 1-stage and 2-stage managements for common bile duct stones and gallstones (CBDS): a retrospective study","volume":"59","author":"Zhou","year":"2025","journal-title":"J Clin Gastroenterol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1412334","DOI":"10.3389\/fsurg.2024.1412334","article-title":"Comparison of the efficacy of LTCBDE and LCBDE for common bile duct stones: a systematic review and meta-analysis","volume":"11","author":"Zheng","year":"2024","journal-title":"Front Surg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"239","DOI":"10.4174\/astr.2016.91.5.239","article-title":"Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis","volume":"91","author":"Lee","year":"2016","journal-title":"Ann Surg Treat Res"},{"key":"B39","doi-asserted-by":"publisher","first-page":"3808","DOI":"10.3390\/jcm9123808","article-title":"Best procedure for the management of common bile duct stones via the Papilla. Literature review and analysis of procedural efficacy and safety","volume":"9","author":"Ishii","year":"2020","journal-title":"J Clin Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"596","DOI":"10.5946\/ce.2018.057","article-title":"Treatment using the SpyGlass digital system in a patient with hepatolithiasis after a Whipple procedure","volume":"51","author":"Harima","year":"2018","journal-title":"Clin Endosc"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1059595","DOI":"10.3389\/fsurg.2023.1059595","article-title":"Electrohydraulic lithotripsy through endoscopic retrograde cholangiopancreatography combined with SpyGlass in the treatment of complex pancreatic duct stones: a case report and literature review","volume":"10","author":"Pu","year":"2023","journal-title":"Front Surg"},{"key":"B42","doi-asserted-by":"publisher","first-page":"3767","DOI":"10.3748\/wjg.v26.i26.3767","article-title":"Spyglass application for duodenoscope working channel inspection: impact on the microbiological surveillance","volume":"26","author":"Liu","year":"2020","journal-title":"World J Gastroenterol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3390\/jcm11020289","article-title":"Peroral cholangioscopy-guided targeted biopsy versus conventional endoscopic transpapillary forceps biopsy for biliary stricture with suspected bile duct cancer","volume":"11","author":"Sekine","year":"2022","journal-title":"J Clin Med"},{"key":"B44","doi-asserted-by":"publisher","first-page":"28","DOI":"10.17116\/hirurgia202210128","article-title":"Oral cholangioscopy for biliary system diseases","author":"Yartsev","year":"2022","journal-title":"Khirurgiia (Mosk)"},{"key":"B45","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2478\/jtim-2020-0025","article-title":"Safety and efficacy of extracorporeal shock wave lithotripsy for difficult-to-retrieve common bile duct stones: a ten-year experience","volume":"8","author":"Manzoor Ul Haque","year":"2020","journal-title":"J Transl Int Med"},{"key":"B46","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1067\/mge.2001.111042","article-title":"Extracorporeal shock wave lithotripsy for clearance of bile duct stones resistant to endoscopic extraction","volume":"53","author":"Sackmann","year":"2001","journal-title":"Gastrointest Endosc"},{"key":"B47","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3109\/00365521.2013.858767","article-title":"Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy: higher failure rate in obese patients","volume":"49","author":"Lenze","year":"2014","journal-title":"Scand J Gastroenterol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1016\/j.dld.2017.05.010","article-title":"Ductal stones recurrence after extracorporeal shock wave lithotripsy for difficult common bile duct stones: predictive factors","volume":"49","author":"Muratori","year":"2017","journal-title":"Dig Liver Dis"},{"key":"B49","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.gie.2014.04.059","article-title":"Extracorporeal shock wave lithotripsy for difficult common bile duct stones: a comparison between 2 different lithotripters in a large cohort of patients","volume":"81","author":"Cecinato","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"B50","first-page":"167","article-title":"Extracorporeal shock wave lithotripsy for the rescue of post-endoscopic or surgically retained biliary duct stones: does saline irrigation affect the outcome?","volume":"4","author":"El-Faqih","year":"1998","journal-title":"Saudi J Gastroenterol"},{"key":"B51","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1055\/a-0637-8806","article-title":"A systematic review of advanced endoscopy-assisted lithotripsy for retained biliary tract stones: laser, electrohydraulic or extracorporeal shock wave","volume":"50","author":"Veld","year":"2018","journal-title":"Endoscopy"},{"key":"B52","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1002\/jhbp.316","article-title":"Ursodeoxycholic acid after bile duct stone removal and risk factors for recurrence: a randomized trial","volume":"23","author":"Yamamoto","year":"2016","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B53","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1055\/s-0043-103956","article-title":"Early adverse events and long-term outcomes of endoscopic sphincterotomy in a pediatric population: a single-center experience","volume":"49","author":"Cho","year":"2017","journal-title":"Endoscopy"},{"key":"B54","doi-asserted-by":"publisher","first-page":"e0995","DOI":"10.1097\/LBR.0000000000000995","article-title":"Basic bronchoscopy competence achieved by a nationwide one-day simulation-based training","volume":"32","author":"Gerretsen","year":"2025","journal-title":"J Bronchology Interv Pulmonol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1016\/j.arth.2021.02.028","article-title":"Deep learning artificial intelligence model for assessment of hip dislocation risk following primary total hip arthroplasty from postoperative radiographs","volume":"36","author":"Rouzrokh","year":"2021","journal-title":"J Arthroplasty"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1658784\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:31:19Z","timestamp":1762929079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1658784\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":55,"alternative-id":["10.3389\/fsurg.2025.1658784"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1658784","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]},"article-number":"1658784"}}