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Open research questions in Gallbladder and Bile Duct Disorders

49 unresolved questions extracted from the limitations and future-work sections of 436 Gallbladder and Bile Duct Disorders papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • In hospitals lacking on-site ERCP, alternative diagnostic and therapeutic strategies are required, but the scope and quality of the supporting evidence remain unclear.

    Management of common bile duct stones in the absence of endoscopic retrograde cholangiopancreatography · 2026 · DOI

  • Importance: As the use of robotic cholecystectomy increases, its value remains poorly defined for complex elective cholecystectomy (CEC), where complex gallbladder pathology results in increased technical difficulty.

    Outcomes and Costs After Robotic vs Laparoscopic Complex Elective Cholecystectomy · 2026 · DOI

  • also reported contradictory evidence suggesting that MRCP often fails to differentiate GA from a severely atrophied or “vanished” gallbladder, resulting in persistent mislabeling as contraction, as also observed in this case [8].

    An Atypical Case of Vanished Gallbladder · 2026 · DOI

  • acute in 12. Wakabayashi G, Iwashita Y, Hibi T, et al. Current early J for evidence and cholecystectomy cholecystitis. Hepatobiliary Pancreat Sci, 2024; 31(2): 95-107. 13. Ahmed A, Hassan M, Mahmood K, et al. Predictors of postoperative complications after laparoscopic cholecystectomy. Asian J Surg, 2023; 46(9): 3712-3718. 14. Al-Jubouri MA, Al-Taie SA, Al-Hamdani AA, et al.

    EARLY VERSUS DELAYED CHOLECYSTECTOMY FOR ACUTE CALCULOUS CHOLECYSTITIS: A COMPARATIVE STUDY OF SURGICAL OUTCOMES AND POSTOPERATIVE COMPLICATIONS AT AL SALAM TEACHING HOSPITAL, MOSUL · 2026 · DOI

  • 8,9 The conclusions that can be drawn from this cohort are inher- ently limited by the retrospective design and small sample size. Further prospective studies comparing APBS with metallic and plastic stents in complex bili- ary anatomy are warranted.

    Articulated plastic biliary stents for complex hilar and bilioenteric strictures · 2026 · DOI

  • However, the capability of both the historical and emerging biliary drainage modalities to normalize total bilirubin in patients with DMBO is underreported and evidence is still lacking, especially regarding the emerging ones.

    Endoscopic biliary drainage techniques for bilirubin normalization in distal malignant biliary obstruction: A comprehensive review · 2026 · DOI

  • While recurrent biliary obstruction—commonly due to tumor ingrowth or stent migration following EUS-BD—remains a major clinical challenge, food impaction within lumen-apposing metal stents (LAMSs) has been rarely reported.

    Case Report: Unexpected LAMS obstruction following successful EUS-BD in a patient with pancreatic carcinoma · 2026 · DOI

  • Although FCSEMS provide important therapeutic advantages due to their removability and reduced tissue ingrowth, stent migration remains a major limitation, with reported migration rates ranging from approximately 20% to 40%, particularly in benign disease where intrinsic anchoring is limited [1].

    Ovesco StentFix for the Fixation of Fully Covered Self-Expanding Metal Stents and Lumen-Apposing Metal Stents Across Diverse Gastrointestinal Indications: A Single-Centre Pilot Case Series · 2026 · DOI

  • Ozaslan E. Difficult cannulation is the most important factor for post-ERCP pancreatitis: what is the mechanism? Gastrointest Endosc 2013;77:313-314. 21. Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015;81: 143-149. 22. Thiruvengadam NR, Saumoy M, Schneider Y, et al. A costeffectiveness retrograde for cholangiopancreatography pancreatitis prophylaxis in the United States. Clin Gastroenterol Hepatol 2022;20:216-226. post-endoscopic analysis 23. Udd M, Kylänpää L, Halttunen J. Management of difficult bile duct cannulation in ERCP. World J Gastrointest Endosc 2010;2:97-103. 24. Mariani A, Di Leo M, Giardullo N, et al. Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial. Endoscopy 2016;48:530-535. 25. Maharshi S, Sharma SS. Early precut versus primary precut sphincterotomy to reduce post-ERCP pancreatitis: randomized controlled trial (with videos). Gastrointest Endosc 2021;93:586-593. 26. Wen J, Li T, Lu Y, Bie LK, Gong B. Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology. Hepatobiliary Pancreat Dis Int 2019;18:73-78.

    Biliary cannulation techniques: Optimizing success and minimizing risk · 2026 · DOI

  • Single center, small sample size. ASA I only with age limited to 20–50 years. Follow-up focused on short-term outcomes, so uncommon or late complications may be missed.

    Comparative analysis of day-surgery versus conventional overnight stay surgery for laparoscopic cholecystectomy · 2026 · DOI

  • This study has several limitations. First, its retrospective singlecenter design may introduce selection bias. Second, the midpoint of the papillary oral protrusion used to categorize incision extent represents a practical endoscopic landmark rather than an anatomical reference, yet it was readily identifiable and showed substantial interobserver agreement. Third, because this was an image-based review, the initial and final TPS incisions were selected for analysis because they represented the most consistently documented steps within each procedure. Although intermediate adjustments were not included in the fi- Su Wei-Chih et al. Technical factors associated … Endosc Int Open 2026; 14: a28631217 | © 2026. The Author(s).

    Technical factors associated with biliary cannulation success after transpancreatic precut sphincterotomy · 2026 · DOI

  • Some earlier reports and studies with less experienced endoscopists found no significant difference in repeat ERCP rates between primary and secondary precut, suggesting the need to validate findings across different levels of operator expertise.

    Safety and Efficacy of Primary Needle-knife Precut during ERCP Procedure · 2026 · DOI

  • Some studies have reported no significant difference in hospital stay between primary and secondary precut groups, particularly in cohorts with high-risk patients or where operator experience varied, indicating that patient characteristics and procedural expertise may influence outcomes and require further clarification.

    Safety and Efficacy of Primary Needle-knife Precut during ERCP Procedure · 2026 · DOI

  • The reported associations between BMI and procedural difficulty often vary depending on patient selection and definitions of difficult cannulation, indicating inconsistency in how these factors are defined and measured across studies.

    Safety and Efficacy of Primary Needle-knife Precut during ERCP Procedure · 2026 · DOI

  • Mechanistic investigations incorporating advanced lipoprotein subfraction analyses, such as direct quantification of small dense LDL particles, may help determine whether alterations in LDL particle composition contribute to biliary cholesterol supersaturation and gallstone pathogenesis.

    A lower LDL-c/ApoB ratio is associated with an increased prevalence of gallstones in the regional Chinese adult population, according to a retrospective, propensity-matched analysis · 2026 · DOI

  • Detailed assessment of lipid-lowering medication use is necessary to minimize residual confounding and better define the independent contribution of LAR.

    A lower LDL-c/ApoB ratio is associated with an increased prevalence of gallstones in the regional Chinese adult population, according to a retrospective, propensity-matched analysis · 2026 · DOI

  • Despite aiming to mitigate bias to the greatest extent possible, the results of this trial should be interpreted in the context of important limitations related to masking and generalisability. First, despite extensive efforts, potential unmasking events did occur (most commonly through radiographic tests obtained within 48 h after ERCP) and could have influenced care. Additionally, since clinicians who are aware of study group assignment could resume care of their patients after 48 h, there was a decay in masking rigor for the secondary outcome. Similarly, adjudicators were provided radiographic information when assessing the severity of post-ERCP pancreatitis, which might have their decision making. Additionally, endoscopists performing the ERCP might have made procedural decisions with knowledge of study group assignment, and it is possible that procedural approach could have been altered according to whether or not a stent would be placed. Lastly, all participating sites were tertiary referral centres and the findings therefore might not be applicable to community endoscopists. influenced In summary, a strategy of indomethacin alone was not as effective as a strategy of indomethacin plus prophylactic pancreatic stent placement. The relative benefit of stent placement appeared more prominent among those at highest risk for post-ERCP pancreatitis. www.thelancet.com Vol 403 February 3, 2024 457 Downloaded for Anonymous User (n/a) at Kirikkale University from ClinicalKey.com by Elsevier on June 16, 2026. For personal use only. No other uses without permission. Copyright ©2026. Elsevier Inc. All rights reserved.

    Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial · 2024 · DOI

  • Future research should focus on this issue to identify better post discharge modalities for tracking patients with PCT to determine the optimal subsequent cholecystectomy when feasible.

    A retrospective study of percutaneous cholecystostomy outcomes in a community hospital · 2024 · DOI

  • The influence of the type of laparoscopic intervention (SILC, 4PLC, LCLT) on the duration of postoperative stay of patients with cholecystolithiasis has not been established.

    Predictors of prolongation of the hospital stay in patients with cholecystolithiasis after laparoscopic surgical interventions on the gallbladder · 2018 · DOI

  • The mechanism of this ERCP-induced complication is not fully understood, although factors increasing the risk of acute pancreatitis, such as sphincter of Oddi dysfunction, previous acute pancreatitis, narrow bile ducts or difficult catheterization of Vater's ampulla are known.

    Endoskopowa ultrasonografia czy endoskopowa cholangiopankreatografia w diagnostyce kamicy żółciowej przewodowej? · 2014 · DOI

  • 15%; Amikacin, Cefalexin, Ceftriaxone, Ofloxacin and Pefloxacin are recommended in premedication; considering the fact that new generation antibiotics have not been tested yet, they were not taken into consideration for this study.

    Bacteriological examination of gallbladder contents · 2002 · DOI

  • Although endoscopic papillary large balloon dilatation is an effective procedure that dilates the Vater’s papilla to remove larger size calculi, gallstone ileus following the procedure as a complication has rarely been reported in the literature.

    Gallstone ileus developing two months after endoscopic papillary large balloon dilatation: a case report · 2026 · DOI

  • To date, vasculobiliary anatomy has been studied using cadaveric dissections, laparoscopic ultraso- nography, and different forms of intraoperative cholangiography; however, reported incidence rates vary widely across the literature.

    Parallel Configuration of the Cystic and Common Hepatic Ducts: a Surgical Odyssey · 2026 · DOI

  • Cystic duct stump or gallbladder remnant calculi, although uncommon, represent an important and often underrecognized cause of persistent or recurrent obstruction, and may be associated with complex pathology such as fistulous communication.

    Post-cholecystectomy Cystic Duct Stump Calculus With Cystic Duct Remnant-Common Bile Duct Fistula Causing Choledocholithiasis: A Report of a Rare Case · 2026 · DOI

  • There is a need for further research of these new inflammatory parameters in multicenter studies with large cohorts, and it would also be useful to investigate these in respect of bile duct pathologies and pancreas inflammation.

    Do NEUT-RI, NEUT-GI, RE-LYMP, and AS-LYMP provide diagnostic value in differentiating acute cholecystitis from biliary colic? · 2026 · DOI

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49 open questions have been extracted from the limitations and future-work passages of 436 Gallbladder and Bile Duct Disorders papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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