In our current practice, all patients with CBD stones at MRCP are considered for ERCP regardless of stone size. Our results would support the hypothesis that as size decreases the likelihood of spontaneous stone passage increases. Although the threshold of mathematical best compromise is >4 mm to minimise both type 1 and type 2 errors, we would favour a lower threshold of 2 mm above which ERCP is performed (sensitivity 98.65, 95% CI 96.1-99.7, specificity 25.71%, CI 16.0-37.6). For patients with stones measuring 2 mm or less, early operative intervention with intraoperative cholangiography to confirm duct clearance could be a suitable alternative.
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