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Video of Issue One-session endoscopic ultrasound-guided cholecystoduodenostomy for treatment of a high-surgical risk patient with symptomatic cholelithiasis of remnant gallbladder
Oscar Víctor Hernández Mondragónorcid, Enrique Murcio-Pérezorcid, José Martín Hernández Márquezorcid
Clinical Endoscopy 2025;58(2):322-323.
DOI: https://doi.org/10.5946/ce.2024.185
Published online: February 17, 2025

Department of Endoscopy, Specialties Hospital, XXI Century National Medical Center, Mexico City, Mexico

Correspondence: Oscar Víctor Hernández Mondragón Department of Endoscopy, Specialties Hospital, XXI Century National Medical Center, Cuauhtémoc Avenue 330, 06700 Mexico City, Mexico E-mail: mondragonmd@yahoo.co.uk
• Received: July 6, 2024   • Revised: August 15, 2024   • Accepted: August 16, 2024

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Subtotal cholecystectomy is frequently performed in patients with acute cholecystitis and difficult anatomy.1 Symptomatic stones in the remnant gallbladder are an uncommon cause of post-cholecystectomy syndrome. Minimally invasive surgery includes laparoscopic and robot-assisted approaches; however, not all patients are candidates for severe fibrosis or high-risk clinical conditions.2 Endoscopic ultrasound-guided cholecystoduodenostomy (EUS-CD) represents a temporary alternative in high-risk patients with acute cholecystitis.3 However, stent removal and evaluation in other clinical scenarios, such as symptomatic cholelithiasis, have not been performed. Here, we present a case of EUS-CD in a high-risk surgical patient with symptomatic stones in the remnant gallbladder.
A 92 years-old patient with multiple comorbidities and a history of open subtotal cholecystectomy performed 29 years previously presented with intermittent right upper quadrant abdominal pain. Symptomatic cholelithiasis of the remnant gallbladder is confirmed. After discussing the potential therapeutic options, surgery was refused, and the endoscopic approach was accepted. A linear echoendoscope was introduced and a 15 mm gallstone in the 28×26 mm remnant gallbladder was identified. EUS-CD was performed using a 15×10 mm Hot AXIOS stent (Boston Scientific), and the stone was completely removed.
One-session stent extraction was performed because of the high probability of postsurgical fibrosis. Closure was performed using a mantis-like claw clip (Mantis clip; Boston Scientific). An hidrosoluble contrast study at 24-hours showed no leakage. A liquid diet was initiated and progressed to a soft and normal diet during the following week, and the patient was discharged after 5 days. Upper endoscopy at one month showed a remnant-placed clip in the duodenal bulb, and no clinical signs of abdominal pain were present during follow-up (Fig. 1, Video 1).
In conclusion, EUS-CD with same-session stent extraction represents an alternative treatment for symptomatic cholelithiasis of the remnant gallbladder in high-risk surgical patients.

Video 1.

One-session endoscopic ultrasound guided cholecystoduodenostomy for treatment of a high-surgical risk patient with symptomatic cholelithiasis of remnant gallbladder.
A video related to this article can be found online at https://doi.org/ce.2024.185.
Fig. 1.
(A) A 15-mm stone was identified within a large remnant gallbladder. (B) Puncture of the remnant gallbladder with a 10×15 mm Hot AXIOS stent through the duodenal bulb under fluoroscopic control. (C) Access through the cholecysto-duodenostomy. Lithotripsy and extraction of the stone with a basket was performed. (D, E) Same-session stent extraction was performed based on the high probability of postsurgical fibrosis between the gallbladder and the duodenal wall. (F) Full-thickness mucosal closure with mantis-like claw clips.
ce-2024-185f1.jpg
  • 1. Elshaer M, Gravante G, Thomas K, et al. Subtotal cholecystectomy for “difficult gallbladders”: systematic review and meta-analysis. JAMA Surg 2015;150:159–168.ArticlePubMed
  • 2. Kumar S, Kurian N, Singh RK, et al. Surgical management of cystic duct stump calculi causing post-cholecystectomy syndrome: a prospective study. J Minim Access Surg 2023;19:257–262.ArticlePubMedPMC
  • 3. McCarty TR, Hathorn KE, Bazarbashi AN, et al. Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis. Surg Endosc 2021;35:4964–4985.ArticlePubMedPDF

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        One-session endoscopic ultrasound-guided cholecystoduodenostomy for treatment of a high-surgical risk patient with symptomatic cholelithiasis of remnant gallbladder
        Clin Endosc. 2025;58(2):322-323.   Published online February 17, 2025
        DOI: https://doi.org/10.5946/ce.2024.185
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      One-session endoscopic ultrasound-guided cholecystoduodenostomy for treatment of a high-surgical risk patient with symptomatic cholelithiasis of remnant gallbladder
      Image
      Fig. 1. (A) A 15-mm stone was identified within a large remnant gallbladder. (B) Puncture of the remnant gallbladder with a 10×15 mm Hot AXIOS stent through the duodenal bulb under fluoroscopic control. (C) Access through the cholecysto-duodenostomy. Lithotripsy and extraction of the stone with a basket was performed. (D, E) Same-session stent extraction was performed based on the high probability of postsurgical fibrosis between the gallbladder and the duodenal wall. (F) Full-thickness mucosal closure with mantis-like claw clips.

      Fig. 1.

      One-session endoscopic ultrasound-guided cholecystoduodenostomy for treatment of a high-surgical risk patient with symptomatic cholelithiasis of remnant gallbladder
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