Clin Endosc.  2023 May;56(3):375-380. 10.5946/ce.2021.273.

Successful removal of remnant cystic duct stump stone using single-operator cholangioscopy-guided electrohydraulic lithotripsy: two case reports

• Ryou SH
• Kim HJ

• KMID: 2542465
• DOI: http://doi.org/10.5946/ce.2021.273

Abstract

Cholecystectomy is the best method for treating gallstone diseases. However, 10%–30% of patients who undergo a cholecystectomy continue to complain of upper abdominal pain, dyspepsia, or jaundice—this is referred to as postcholecystectomy syndrome. Cystic duct stump stones are a troublesome cause of postcholecystectomy syndrome. Conventionally, surgery is mainly performed to remove cystic duct stump stones. However, repeated surgery can cause complications, such as postoperative bleeding, biliary injury, and wound infection. As an alternative method of surgery, endoscopic retrograde cholangiopancreatography is sometimes used to remove cystic duct stump stones, although the success rate is not high due to technical difficulties. Recently, peroral cholangioscopy, which can directly observe the bile duct, has been suggested as an alternative method. We report two cases in which a cystic duct stump stone was successfully removed via a single-operator cholangioscopy, after failure with an endoscopic retrograde cholangiopancreatography.

Keyword

Cystic duct stump stone; Electrohydraulic lithotripsy; Oral cholangioscopy; Postcholecystectomy syndrome; Single-operator cholangioscopy

Figure

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  Fig. 1. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography findings. (A) An 8-mm-sized filling defect (arrow) in the remnant cystic duct compressing the proximal common bile duct and dilating the remnant cystic duct stump. (B) The impacted cystic duct stone (arrow) is observed on ERCP.

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  Fig. 2. Removal of the cystic duct stump stone by single-operator cholangioscopy (SOC) with electrohydraulic lithotripsy (EHL) and follow-up endoscopic retrograde cholangiopancreatography (ERCP) findings after endoscopic treatment. (A) The impacted stone (arrow) is observed on the cystic duct stump by SOC. (B) After using EHL, the stone was removed. (C) There is no evidence of the cystic duct stump stone on ERCP.

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  Fig. 3. Abdominopelvic computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) findings. (A) Remnant cystic duct dilatation (arrow) with common bile duct dilatation is observed on CT. (B) The stone is impacted in the cystic duct stump (arrow).

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  Fig. 4. Removal of cystic duct stump stone by single-operator cholangioscopy (SOC) with electrohydraulic lithotripsy (EHL) and follow-up endoscopic retrograde cholangiopancreatography (ERCP) findings after endoscopic treatment. (A) The impacted stone (arrow) is observed on the cystic duct stump by SOC. (B) Fluoroscopic image of SOC (arrow) targeting the impacted cystic duct stone. (C) The stone was fragmented using EHL. (D) There is no evidence of the cystic duct stump stone on ERCP.

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