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Multi-center Study of the Association Between Serum Lipid Levels and Recurrent Common Bile Duct Stone After Endoscopic Retrograde Cholangiopancreatography with Propensity Score Matching Analysis - Digestive Diseases and Sciences Background Recurrent common bile duct (CBD) stones after endoscopic retrograde cholangiopancreatography (ERCP) is a significant clinical issue. While the association between serum lipid levels and gallstones has been established, its impact on recurrent CBD stone is less clear. This study aims to investigate the association between serum lipid levels and recurrent CBD stone, further subclassified into different subgroups. We also try to explore effective drugs to decrease the occurrence of recurrent CBD stone. Materials and Methods This multi-institutional study acquired patients’ data from Chang Gung Memorial Hospitals using Chang Gung Research Database (CGRD) from 2002/1/1 to 2020/12/31. We analyzed the association between metabolic risk factors and recurrent CBD stone after ERCP using propensity score matching and then subclassified these patients into cholecystectomy, cirrhosis, and hyperlipidemia. Additionally, medications aimed at controlling serum lipid levels were investigated for their potential to reduce the recurrence rate of CBD stones. Results Totally, 5132 patients were enrolled. Our results showed that higher cholesterol level and HbA1C above 6.5% are risk factors of CBD stone recurrence after ERCP when using propensity score matching. However, triglyceride (TG) and high-density lipoprotein (HDL) were presented as protective factors. These metabolic factors may be variable in different subgroups. Additionally, statin and aspirin might be effective drugs to reduce CBD stone recurrence rate. Conclusions Serum lipid level and HbA1C were found to be associated with recurrent CBD stone after ERCP but variable in different subgroups. Statin and aspirin might reduce the risk of CBD stone recurrence. https://link.springer.com/article/10.1007/s10620-025-09622-7