Endoscopic management of cystic duct remnant stones causing post-cholecystectomy syndrome: A multi-center experience

Authors

• Yousif Arif, Department of Internal Medicine, University of California, Los Angeles, CA; Division of Digestive Diseases, University of California, Los Angeles, CA.
• Thomas Tielleman, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX.
• Khaled Alchirazi, Advocate Health - MidwestFollow
• Jennifer Kolb, Department of Internal Medicine, University of California, Los Angeles, CA; Division of Digestive Diseases, University of California, Los Angeles, CA.
• Firas Bahdi, Department of Internal Medicine, University of California, Los Angeles, CA; Division of Digestive Diseases, University of California, Los Angeles, CA.
• Mohanad Awadalla, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
• Jennifer Phan, Department of Internal Medicine, University of California, Los Angeles, CA; Division of Digestive Diseases, University of California, Los Angeles, CA.
• Shawn Shah, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX.
• Moamen Gabr, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
• Douglas Pleskow, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
• Mohammad Bilal, Division of Gastroenterology and Hepatology, Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota, USA.
• Douglas G. Adler, Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, CO.
• Danny Issa, Department of Internal Medicine, University of California, Los Angeles, CA; Division of Digestive Diseases, University of California, Los Angeles, CA.

Recommended Citation

Arif Y, Tielleman T, Alchirazi K, et al. Endoscopic Management of Cystic Duct Remnant Stones Causing Post-Cholecystectomy Syndrome: A Multi-Center Experience. Gastrointest Endosc. Published online August 10, 2026. doi:10.1016/j.gie.2026.08.008

Affiliations

Aurora St. Luke's Medical Center

Abstract

Background and aims: Cystic duct remnant (CDR) stones are an underrecognized biliary cause of post-cholecystectomy syndrome (PCS). Surgical excision has been the traditional treatment; however, ERCP may offer a less invasive alternative.

Methods: We conducted a retrospective multi-center study of patients with PCS who underwent ERCP for CDR stones. Primary outcome was technical success (complete stone clearance); secondary outcomes were clinical success and adverse events (AEs).

Results: Twenty-one patients were included (mean age 50 ± 17 years). Technical and clinical success rates were 95% (20/21) and 91% (19/21), respectively. Balloon sweep alone achieved clearance in 43%; cholangioscopy was required in 43%, with electrohydraulic lithotripsy (EHL) used in 89% of those cases. Post-ERCP pancreatitis occurred in two patients (10%), both mild.

Conclusions: ERCP is highly effective and safe for symptomatic CDR stones. Cholangioscopy with EHL is frequently necessary and should be anticipated, particularly for impacted or large stones.

Document Type

Article

PubMed ID

42575378