Management of common bile duct stones in the absence of endoscopic retrograde cholangiopancreatography

BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of common bile duct (CBD) stones; however, it is not universally available. In hospitals lacking on-site ERCP, alternative diagnostic and therapeutic strategies are required, but the scope and quality of the sup- porting evidence remain unclear. AIM To map and synthesize the available literature on non-ERCP diagnostic and therapeutic strategies for CBD stones. METHODS A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. PubMed/MEDLINE and Scopus were searched for studies published between 2020 and 2025 on non-ERCP strategies for CBD stones. Eligible studies included observational and comparative designs. Data were extracted and analyzed descriptively, focusing on diagnostic modalities, surgical strategies, and reported outcomes. RESULTS Seven studies met the inclusion criteria, predominantly retrospective and single- center in design. Magnetic resonance cholangiopancreatography, endoscopic ultrasound, and intraoperative imaging were the most frequently reported diagnostic modalities. Laparoscopic CBD exploration, using transcystic or transductal approaches, was the main therapeutic strategy. Outcomes varied across studies and were closely related to institutional expertise and resource availability. CONCLUSION The available evidence is limited and heterogeneous. Non-ERCP strategies are feasible in selected settings, but current data do not support broad generalization.