The goal of this clinical trial is to compare two different approaches for removing large or multiple stones from the common bile duct in older adults with chronic diseases. The main questions it aims to answer are: Is it better to remove the stones immediately during the first endoscopic procedure? Or is it safer and more effective to place a temporary plastic stent first and remove the stones later? Researchers will compare these two approaches to see which one leads to better stone clearance and fewer complications. Participants will: Undergo an endoscopic procedure (ERCP) to treat their bile duct stones. Be randomly assigned to either have immediate stone removal or have a stent placed first, with stone removal scheduled 8-12 weeks later. Attend follow-up visits to monitor their recovery and check for complications. This study is being conducted at the National Liver Institute, Menoufia University, Egypt.
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Rate of complete stone clearance
Timeframe: One month