Endoscopy 2014; 46(08): 650-655
DOI: 10.1055/s-0034-1365721
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Utility of endoscopic ultrasound to diagnose remnant stones in symptomatic patients after cholecystectomy

Mehdi Mohamadnejad
1  Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
2  Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
,
Sayed Jalal Hashemi
3  Department of Medicine, Division of Gastroenterology, Ahvaz University of Medical Sciences, Ahvaz, Iran
,
Farhad Zamani
2  Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
,
Massoud Baghai-Wadji
4  Department of Surgery, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
,
Reza Malekzadeh
1  Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
,
Mohamad A. Eloubeidi
5  Department of Medicine, Division of Gastroenterology, American University of Beirut, Beirut, Lebanon
› Author Affiliations
Further Information

Publication History

submitted 01 April 2013

accepted after revision 24 March 2014

Publication Date:
30 June 2014 (eFirst)

Background and study aims: Stones in the cystic duct stump (CDS) or gallbladder remnant after cholecystectomy are difficult to identify. The aim of this study was to evaluate the utility of endoscopic ultrasound (EUS) in the diagnosis of stones in the CDS or gallbladder remnant in patients with postcholecystectomy syndrome.

Methods: A prospective study was conducted between January 2011 and December 2012 in consecutive patients with pancreaticobiliary-type pain or acute pancreatitis (n = 112) following cholecystectomy. Diagnostic modalities including EUS were used to diagnose the cause of postcholecystectomy syndrome.

Results: A total of 11 patients (10 %) were found to have stones in the gallbladder remnant (n = 8), CDS (n = 2), or both (n = 1). In eight patients, EUS was the first imaging procedure to make the diagnosis. Seven patients agreed to undergo repeat surgery, and six of them remained free of symptoms postoperatively after a median follow-up period of 4 months (range 1 – 13 months).

Conclusion: EUS may be an important procedure to consider in the study of patients with symptoms after cholecystectomy, as the diagnosis of residual stones is frequently missed by other imaging modalities.