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

Endoscopy retrospective · n=21 · Aug 10, 2026 · GIE · IF 8.0

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

Practice-changingERCPcholedocholithiasishealth services

Clinical takeawayFor symptomatic cystic duct remnant stones causing post-cholecystectomy syndrome, ERCP is a less-invasive alternative to surgical excision. Anticipate escalation to cholangioscopy in approximately 43% of cases, with EHL required in most cholangioscopy cases (89%). Counsel patients on a 10% risk of mild post-ERCP pancreatitis.

What it foundERCP achieved complete stone clearance in 95% (20/21) and clinical success in 91% (19/21) of 21 patients with post-cholecystectomy syndrome from cystic duct remnant stones. Balloon sweep alone succeeded in 43%; cholangioscopy was required in 43%, with EHL used in 89% of those cholangioscopy cases. Post-ERCP pancreatitis occurred in 10% (2/21), both mild.

ContextCystic duct remnant stones are an underrecognized cause of post-cholecystectomy syndrome. Surgery was traditionally the standard treatment; this retrospective multi-center series demonstrates that ERCP is highly effective and less invasive, shifting the initial management paradigm for symptomatic patients.

Refinessuggested applicable standard· Annals of Medicine (Taylor & Francis), "Clinical perspectives on post-cholecystectomy syndrome: a narrative review," 2025

Decision at stakeWhen cystic duct remnant stones cause post-cholecystectomy syndrome, choose the management approach.

Address the specific underlying cause of persistent or new post-cholecystectomy symptoms after narrowing the heterogeneous differential (retained/CBD stone, sphincter of Oddi dysfunction, bile leak/duct injury, bile acid diarrhea, functional dyspepsia/IBS, GERD). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Address the specific underlying cause of persistent or new post-cholecystectomy symptoms after narrowing the heterogeneous differential (retained/CBD stone, sphincter of Oddi dysfunction, bile leak/duct injury, bile acid diarrhea, functional dyspepsia/IBS, GERD). First exclude time-sensitive early postoperative complications, bile leak/duct injury, obstructing retained/CBD stone, biliary obstruction or cholangitis, and treat red-flag features (jaundice, fever, sepsis, or early-onset/worsening pain) as warranting prompt evaluation rather than reassurance; only then reassure that most symptoms settle within 6-12 months, avoid empiric reoperation, and obtain multidisciplinary GI + HPB surgery input for refractory or atypical cases.

Annals of Medicine (Taylor & Francis), "Clinical perspectives on post-cholecystectomy syndrome: a narrative review," 2025 · reviewed 2026-07-23 ↗

Arif Y … Issa D · Gastrointestinal Endoscopy · IF 8.0 · PubMed ↗Permalink