Successful Removal of Remnant Cystic Duct Stump Stone Using Single-Operator Cholangioscopy-Guided Lithotripsy in a Tertiary Care Center

Introduction: Cholecystectomy is the best method for treating gallstone diseases. Conventionally, surgery is mainly performed to remove cystic duct stump stones. 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.

Case: 51-year-old male admitted with complains of pain abdomen for past 2 years, vomiting jaundice for past 2 months. All relevant investigations were done. MRCP shows moderate to grossly dilated IHBR, CHD, CBD calculus in mid and distal CBD. ERCP was done, few caliculi were extracted and it shows large stone for which laser lithotripsy was done. Laser lithotripsy was done, spy cholangioscopy performed identified stone in cystic duct stump, direct guided laser lithotripsy done, complete pulverization achieved, CBD and cystic duct clearance achieved.

Discussion: The incidence of cystic duct stump stone after a laparoscopic subtotal cholecystectomy was 4.19 and 0.02% after a laparoscopic total cholecystectomy. MRCP is the most accurate diagnostic method for cystic duct stump stone with sensitivity of 97%. The second-generation SpyGlass DS System, the quality and stability of images were improved. Treatment of bile duct stones using SOC-guided EHL or laser lithotripsy showed a success rate of 80–98%.

Conclusion: In conclusion, we report a case in which the cystic duct stump stones, which were difficult to remove with an ERCP, were successfully removed with electrohydraulic lithotripsy via single operator cholangioscopy using the SpyGlass DS system.

Publication History

Article published online:
22 April 2024