In a recent issue of Gut, I read with interest the guidelines on the management of common bile duct stones by Williams et al (Gut 2008;57:1004–21) and would like to thank the authors for providing these recommendations. However, I have some comments with regard to the management of common bile duct stones in the setting of acute biliary pancreatitis (ABP).

The authors state that “patients with (predicted) severe pancreatitis of suspected or proven biliary origin should undergo biliary sphincterotomy ± endoscopic stone extraction within 72 h of presentation”. Generally, this recommendation reflects the literature published until 2005. However, some more recent randomised controlled trials (RCTs)1 2 and a meta-analysis3 escaped the attention of Dr Williams and his colleagues. In particular, the recent meta-analysis found that co-existing acute cholangitis …