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Updated: Aug 13, 2026
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
Endoscopic management of cystic duct remnant stones causing postcholecystectomy syndrome: a multicenter experience
Yousif Arif1, Thomas Tielleman2, Khaled Alchirazi3
1Department of Internal Medicine, University of California, Los Angeles, California, USA; Division of Digestive Diseases, University of California, Los Angeles, California, USA.
Background And Aims:
Cystic duct remnant (CDR) stones are an under-recognized biliary cause of postcholecystectomy syndrome (PCS). Surgical excision has been the traditional treatment; however, ERCP may offer a less invasive alternative.
Methods:
We conducted a retrospective multicenter study of patients with PCS who underwent ERCP for CDR stones. The primary outcome was technical success (complete stone clearance); secondary outcomes were clinical success and adverse events.
Results:
Twenty-one patients were included (mean age, 50 ± 17 years). Technical and clinical success rates were 95% (20 of 21) and 91% (19 of 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 2 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.
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