Marcelino LP, Thofehrn S, Eyff TF, et al. - The management course of choledocholithiasis often involves multiple treatments, sometimes without success. Researchers conducted a retrospective, case–control study investigating the factors predictive of the success of treatment with retrograde endoscopic cholangiopancreatography (ERCP). From a biliary disease database at Hospital de Clínicas de Porto Alegre (HCPA), patients with successful biliary clearance after one ERCP procedure (Group 1) were compared with those with unsuccessful biliary clearance after one ERCP procedure (Group 2) with respect to demographic, clinical, radiological and procedure-related variables. Group 1 included 320 patients, while Group 2 included 254. Older age, previous biliary exploration, elevated serum total bilirubin, choledocholithiasis above the level of the confluence of the hepatic ducts, stones retained in the cystic duct or Mirizzi syndrome, dilatation of the bile duct diagnosed during ERCP, and the need for suprapapillary opening were noted to be independently linked with the failure of the first ERCP to achieve bile duct clearance. The success of endoscopic treatment was observed in correlation with the performance of imaging at the same institution prior to the procedure and the retention of stones in the duodenal papilla. When considered in conjunction with the results of previously published studies, these variables can be employed to guide the choice of therapeutic methods for patients with choledocholithiasis in the future, given the significant disparity in outcomes between the two groups