Endoscopic Management of Cystic Duct Remnant Stones Causing Post-Cholecystectomy Syndrome: A Multi-Center Experience.

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.