Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for common bile duct stones (CBDS). Identifying predictors of procedural success and complications is essential to improve risk stratification. This study evaluated the efficacy, safety, and independent predictors of outcomes in patients undergoing ERCP for symptomatic CBDS.

A retrospective cohort study was conducted over a one-year period, including all consecutive patients undergoing ERCP for symptomatic CBDS. Clinical presentation, stone characteristics, procedural techniques, technical success, duct clearance, and post-ERCP complications were recorded. Variables associated with incomplete duct clearance and complications were analyzed using univariate and multivariate logistic regression.

A total of 102 patients were included (mean age 52 ± 12.5 years; 59% female). Clinical presentation consisted of biliary colic in 80 cases, acute cholangitis in 18, and biliary pancreatitis in 4. The mean stone size was 12.5 mm, and bile duct dilation was present in 81% of patients (mean diameter 15 mm). Selective biliary cannulation was achieved in 91% of cases; sphincterotomy was performed in 92% and temporary biliary stenting in 12%. Complete duct clearance during the index ERCP was obtained in 85%, with an overall therapeutic success rate of 90%. Complications occurred in 10% of procedures, including post-ERCP pancreatitis (6%), perforation (3%), and minor bleeding (1%), with no procedure-related mortality. In multivariate logistic regression, stone size ≥ 15 mm (OR 3.2; 95% CI 1.3–7.8; p = 0.01) and difficult cannulation (OR 2.9; 95% CI 1.1–7.3; p = 0.02) were independent predictors of incomplete duct clearance, while female sex (OR 2.7; p = 0.03) and bile duct dilation ≥ 15 mm (OR 3.5; 95% CI 1.3–9.1; p = 0.01) were independently associated with post-ERCP complications.

ERCP shows high efficacy and an acceptable safety profile in CBDS. Stone size, cannulation difficulty, bile duct dilation, and sex independently affect outcomes. Incorporating these factors into pre-procedural assessment may improve risk stratification and clinical decision-making.