Remaining issues of recommended management in current guidelines for asymptomatic common bile duct stones

Table 1 Recommended management and evidence level in current guidelines for asymptomatic common bile duct stones

Guideline	Recommendation
ESGE[1]	ESGE recommends stone extraction in all patients with CBDS, regardless of being symptomatic or not, who are fit enough to tolerate the intervention. (Strong recommendation, low quality evidence)
BSG[3]	Stone extraction is recommended in patients diagnosed with CBDS if possible. Evidence of benefit of stone extraction is greatest for symptomatic patients (Low quality evidence; strong recommendation)
JGES[4]	Asymptomatic choledocholithiasis should be treated because of a risk of developing biliary complications. [Evidence level: A; Strength of recommendation (agreement rate): 2 (100%)]
ASGE[5]	CBDS should be treated if detected regardless of the presence or absence of significant mitigating clinical circumstances (Moderate quality)

CBDS: Common bile duct stones; ESGE: European Society of Gastrointestinal Endoscopy; BSG: The British Society of Gastroenterology; ASGE: American Society for Gastrointestinal Endoscopy; JSGE: The Japanese Society of Gastroenterology.