Impact of Stone Size on the Technical Success of Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stone Extraction in Older Adults: A Single-Center Retrospective Study at a Secondary Care Hospital in Mexico

BackgroundCommon bile duct stone size is a recognized determinant of technical difficulty during endoscopic retrograde cholangiopancreatography (ERCP), but evidence focused on older adults in secondary-care settings remains limited.This study evaluated the association between maximum stone size and technical success of ERCP stone extraction in adults aged 60 years or older with choledocholithiasis. MethodsThis retrospective single-center study included 41 adults aged 60 years or older who underwent ERCP for choledocholithiasis at a secondary-care hospital in Mexico between January and December 2025.Maximum stone size was categorized as <15 mm or ≥15 mm.Technical success was defined as complete endoscopic stone extraction without the need for surgical bile duct exploration.Associations were evaluated using Fisher's exact test, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for technical failure. ResultsTechnical success was achieved in 32 of 41 patients (78.0%).Success was significantly higher in patients with stones <15 mm than in those with stones ≥15 mm (89.7% vs. 50.0%;p = 0.011).Stones ≥15 mm were associated with greater odds of technical failure (OR, 8.67; 95% CI, 1.67-44.94).Median maximum stone size was 10 mm among successful procedures and 15 mm among failures (p = 0.002).Common bile duct diameter was also greater among patients with technical failure (15 vs. 12 mm; p = 0.007).Exploratory multivariable analyses produced imprecise estimates because only nine technical failures occurred. ConclusionsIn this cohort of older adults with choledocholithiasis, stones ≥ 15 mm were associated with substantially lower technical success of ERCP stone extraction.Stone size may therefore serve as a clinically useful marker of anticipated technical difficulty and help inform procedural planning.Larger prospective and multicenter studies are needed to determine the independent contribution of stone size to ERCP outcomes.