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Successful removal of remnant cystic duct stump stone using single-operator cholangioscopy-guided electrohydraulic
Sung Hyeok Ryou1, Hong Ja Kim1
1Department of Gastroenterology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
Insights
Cystic duct stump stones cause postcholecystectomy syndrome. Direct visualization with single-operator cholangioscopy offers a successful alternative for stone removal when other methods fail.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Biliary Endoscopy
Background:
- Cholecystectomy is standard for gallstones, but postcholecystectomy syndrome affects 10-30% of patients.
- Cystic duct stump stones are a common cause of persistent symptoms after gallbladder removal.
- Conventional surgical re-intervention carries risks like bleeding and biliary injury.
Observation:
- Endoscopic retrograde cholangiopancreatography (ERCP) has limited success for stump stone removal due to technical challenges.
- Peroral cholangioscopy provides direct visualization of the bile duct, offering a potential alternative.
- Two cases of successful cystic duct stump stone removal using single-operator cholangioscopy are presented.
Findings:
- Single-operator cholangioscopy enabled direct visualization and successful removal of cystic duct stump stones.
- This technique was effective even after prior unsuccessful attempts with ERCP.
- The procedure was performed successfully in both reported cases.
Implications:
- Peroral cholangioscopy represents a promising, less invasive option for managing cystic duct stump stones.
- This approach may reduce the need for repeat surgeries and associated complications.
- Further studies are warranted to establish cholangioscopy as a standard treatment for postcholecystectomy syndrome.
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.
