Routine Nasobiliary Cholangiography After ERCP for Choledocholithiasis May Be Unnecessary: A Single-Center Retrospective Cohort Study.

Objective: To evaluate the necessity of routine nasobiliary cholangiography (NBC) after Endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones (CBDS) by comparing outcomes between patients with and without post-ERCP NBC. Methods: Consecutive patients who underwent ERCP with CBDS extraction between January 2021 and June 2024. We compared the outcomes of patients who underwent NBC versus those who did not receive NBC after ERCP for CBDS extraction. The primary outcome was the incidence rate of residual stones (detected within≤6 months). Secondary outcomes included recurrence of CBDS (more than 6 months), hospitalization duration, antibiotic use duration, and overall cost. Multivariate logistic regression was used to identify independent predictors, reported with odds ratios (ORs) and 95% confidence intervals (CIs). Results: The overall residual stone rate was 5.2% (16/308). The residual stone rate was 7.1% (10/141) in the NBC group, compared to 3.6% (6/167) in the no-NBC group, with no statistically significant difference between the groups (p=0.168). Post-ERCP NBC significantly increased costs (p<0.01). Large stone diameter (OR=5.48, 95% CI: 1.16-25.87) was an independent predictor for residual stones. Conclusion: Routine NBC after ERCP for CBDS may not be necessary as it did not reduce residual stone rates but increased costs. NBC should be considered selectively for patients with large stone diameter (>11.06 mm) or multiple stones.