Treatment is generally recommended when bile duct stones cause symptoms or complications such as persistent upper abdominal pain, jaundice, cholangitis or pancreatitis. Symptoms can be similar to those caused by gallstones and may include upper abdominal pain and nausea, particularly after eating rich or fatty foods. If a stone blocks the bile duct, it may cause jaundice, dark urine, pale stools and itching. The combination of fever, abdominal pain and jaundice may indicate cholangitis, which requires urgent medical treatment.

Small gallstones, biliary crystals or sludge can also pass into the bile duct and obstruct the opening of the pancreatic duct. This can lead to acute pancreatitis, which typically causes severe upper abdominal pain, nausea and vomiting and often requires admission to hospital.

Assessment usually begins with blood tests and an ultrasound scan. If bile duct stones are suspected, magnetic resonance cholangiopancreatography (MRCP) can provide detailed images of the bile ducts without the need for an invasive procedure. Endoscopic ultrasound may be used to identify smaller stones or biliary sludge, while a CT scan may be recommended if complications or alternative diagnoses need to be considered.

Some bile duct stones pass naturally into the bowel without treatment. However, symptomatic stones usually need to be removed and the bile duct cleared. This is most commonly achieved using endoscopic retrograde cholangiopancreatography (ERCP), which allows the bile duct to be accessed without abdominal surgery. A specialist endoscope is passed through the mouth and into the duodenum, where the opening of the bile duct can be widened and the stones removed. A temporary stent may also be inserted if additional drainage is required.

In selected patients, bile duct stone removal may instead be carried out during keyhole gallbladder surgery using laparoscopic common bile duct exploration. This procedure may be performed at the same time as a laparoscopic cholecystectomy, depending on the size, number and position of the stones, as well as the individual surgical circumstances.

If the gallbladder is still present and gallstones were the underlying cause, laparoscopic cholecystectomy is usually recommended following bile duct clearance. Removing the gallbladder helps to reduce the risk of further bile duct stones and complications such as jaundice, cholangitis or pancreatitis.