Aims
Cholecystectomy is recommended in patients with gallstones after endoscopic extraction of bile duct stones to prevent cholecystitis or recurrent gallstones.
However, recurrence of common bile duct (CBD) stones is still observed in a considerable number of patients after cholecystectomy.
The standard treatment is endoscopic retrograde cholangiopancreatography (ERCP).
The aim of this study is to determine the profiles of these patients.
Methods
The endoscopic retrograde cholangiopancreatography (ERCP) database of our hepatology-gastroenterology department was retrospectively reviewed between January 2020 and October 2025. All patients with a history of cholecystectomy and presenting with stones in the common bile duct were included in the study.
Results
Twenty-eight patients were included in the study. The mean age of our patients was 66 ± 14.1 years, with a female predominance of 78% (n = 21) and a female-to-male ratio of 3.5.
The median interval between cholecystectomy and the occurrence of common bile duct stones was 10 years.
The medical histories of our patients were as follows: diabetes in 7 cases (25%), oral contraceptive use in 9 cases (33%), dyslipidemia in 9 cases (33%), obesity in 8 cases (29%), LPAC syndrome in 1 case (3%), sickle cell disease in 1 case (3%), and 3 patients (10%) had no medical history.
The clinical presentation was dominated by biliary colic in 13 cases (48%), acute cholangitis in 10 cases (37%), acute pancreatitis in 3 cases (11%), cholecystitis in 2 cases (7%), and a sickle cell crisis in 1 case (3%).
All patients underwent imaging, which showed dilation of the biliary ducts upstream of lithiasic obstruction.
The mean CBD diameter was 15 mm, ranging from 9 mm to 22 mm.
The number and size of stones within the CBD varied:
• Macro-stone in 10 cases (36%) with a mean diameter of 14.4 mm.
• Two stones in 4 cases (14%) with a mean diameter of 17 mm.
• Multiple stones (choledocholithiasis impaction) in 14 cases (50%)
Conclusions
The recurrence of common bile duct stones is considered an unresolved problem after cholecystectomy. These patients present multiple risk factors, particularly metabolic syndrome, and a more frequent follow-up evaluation is suggested for the early detection of recurrent CBD stones.