title: Utility of endoscopic ultrasound to diagnose remnant stones in symptomatic patients after cholecystectomy.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mehdi
authors: M
authors: Mohamadnejad
authors: Department of Medicine, Division of Gastroenterology, Ahvaz University of Medical Sciences, Ahvaz, Iran.
authors: Sayed Jalal
authors: SJ
authors: Hashemi
authors: Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Farhad
authors: F
authors: Zamani
authors: Department of Surgery, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors: Massoud
authors: M
authors: Baghai-Wadji
authors: Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Reza
authors: R
authors: Malekzadeh
authors: Department of Medicine, Division of Gastroenterology, American University of Beirut, Beirut, Lebanon.
authors: Mohamad A
authors: MA
authors: Eloubeidi
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects*; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology; D017562:Postcholecystectomy Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation