We would like to thank Kayashima et al. for their thoughtful letter on our recently published meta-analysis, which found that there is an increased risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients with asymptomatic choledocholithiasis compared to symptomatic patients [
1]. The crux of their letter is that asymptomatic patients, particularly those with diminutive (< 4 mm) bile duct stones, may benefit from a conservative watch-and-wait approach. They support this with data from studies suggesting a lower risk of adverse events with this approach and that diminutive stones may potentially pass without intervention. …
