A residual cystic duct stone may occur in up to 40% of patients within a period ranging from 2 days to 25 years after cholecystectomy. Traditionally, management has relied mainly on surgical intervention. This study aimed to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of residual cystic duct stones in cholecystectomized patients.

This was a retrospective descriptive study including all cholecystectomized patients presenting with residual cystic duct stones. Data were collected over a 4-year period, from 2021 to 2025.

Among 83 patients who underwent cholecystectomy and presented with post-cholecystectomy syndrome, 31.3% (n=26) were found to have a residual cystic duct stone. The male-to-female ratio was 0.3, with a clear female predominance (76.9%, n=20) compared to males (23.1%, n=6).

The main reasons for hospitalization were isolated hepatic colic in 34.6% (n=9) of cases and acute cholangitis in 65.4% (n=17).

Imaging studies (abdominal ultrasound and Magnetic Resonance Cholangiopancreatography MRCP) revealed one or more stones in the cystic duct in 42.3% (n=11) of patients, associated with residual stones in the common bile duct (CBD) in 69.2% (n=18). Additionally, 15.4% (n=4) of patients presented with isolated CBD dilatation without an identifiable obstruction.

ERCP identified residual cystic duct stones in 100% (n=26) of cases and CBD stones in 73.1% (n=19), among which 19.2% (n=5) were associated with Mirizzi syndrome.

The median size of cystic duct stones was 15 mm [6–20], while that of CBD stones was 16.3 mm [8–25].

Endoscopic extraction of cystic duct stones via ERCP was successfully achieved in 73.1% of cases (n=19). The main causes of failure included stone shape (n=2), normal CBD caliber (n=3), stone size (n=1), and multiple stones (n=1). In cases where extraction failed (26.9%, n=7), a plastic biliary stent was placed to ensure effective drainage before referring patients for surgery.

This study highlights the crucial role of ERCP in the management of residual cystic duct stones in cholecystectomized patients, with a therapeutic success rate of approximately 73%. ERCP represents an effective and minimally invasive alternative to surgery, particularly for patients with high operative risk.