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HOME > Clin Endosc > Volume 57(2); 2024 > Article
Video of Issue A remnant cystic duct presenting as a duodenal subepithelial tumor
Gwang Ha Kim,orcid, Dong Chan Jooorcid
Clinical Endoscopy 2024;57(2):268-269.
DOI: https://doi.org/10.5946/ce.2023.275
Published online: February 2, 2024

Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Correspondence: Gwang Ha Kim Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea E-mail: doc0224@pusan.ac.kr
• Received: October 28, 2023   • Revised: November 10, 2023   • Accepted: November 11, 2023

© 2024 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://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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A 51-year-old man was referred to our institution because of a subepithelial tumor (SET) of the duodenum, which was detected incidentally during esophagogastroduodenoscopy (EGD). Twenty years earlier, he had undergone a cholecystectomy because of cholelithiasis. During EGD, an SET-like lesion, covered by normal duodenal mucosa, was observed in the anterior wall of the duodenal bulb (Fig. 1A). Endoscopic ultrasonography (EUS) using a 20-MHz catheter probe (UM3D-DP20-25R; Olympus) revealed a 0.8×0.6 cm-sized anechoic lesion with hyperechoic suture material outside the duodenal wall (Fig. 1B, C), which was connected to the common bile duct. No Doppler flow was detected by 7.5-MHz conventional EUS using a radial echoendoscope (GF-UE260-AL5; Olympus) (Fig. 1D, Video 1). Abdominal computed tomography scans also showed a remnant cystic duct with suture material (Fig. 2). Therefore, the lesion was diagnosed as a duodenal SET-like lesion caused by a remnant cystic duct.
A remnant cystic duct occurring after cholecystectomy can cause an SET-like lesion in the duodenum, particularly when the SET-like lesion is in the anterior side of the duodenal bulb in patients with a history of cholecystectomy. Although it is very rare, adenocarcinoma can arise from such a remnant cystic duct.1 Detailed examination of a remnant cystic duct by EUS is necessary to avoid missing malignant tumors or stones in the remnant duct.2,3
Video 1. Endoscopic ultrasonography of a duodenal subepithelial lesion.
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A video related to this article can be found online at https://doi.org/10.5946/ce.2023.275.
Fig. 1.
Endoscopic ultrasonography (EUS) findings. (A) A 1-cm-sized subepithelial lesion covered by normal duodenal mucosa is observed in the anterior wall of the duodenal bulb. (B, C) EUS using a 20-MHz catheter probe reveals a 0.8×0.6 cm-sized anechoic lesion with hyperechoic suture material (arrow) outside the duodenal wall. (D) Conventional EUS (7.5 MHz) reveals that the anechoic lesion was connected to the common bile duct and had no Doppler flow (arrow).
ce-2023-275f1.jpg
Fig. 2.
Abdominal computed tomography reveals a remnant cystic duct with suture material (arrows). (A) Transverse section view. (B) Coronal section view.
ce-2023-275f2.jpg
  • 1. Eum JS, Kim GH, Park CH, et al. A remnant cystic duct cancer presenting as a duodenal submucosal tumor. Gastrointest Endosc 2008;67:975–976.Article
  • 2. Han SY, Chon HK, Kim SH, et al. Quality indicators of endoscopic ultrasound in the pancreatobiliary system: a brief review of current guidelines. Clin Endosc 2024;57:158–163.Article
  • 3. Ryou SH, Kim HJ. Successful removal of remnant cystic duct stump stone using single-operator cholangioscopy-guided electrohydraulic lithotripsy: two case reports. Clin Endosc 2023;56:375–380.ArticlePubMedPMCPDF

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        A remnant cystic duct presenting as a duodenal subepithelial tumor
        Clin Endosc. 2024;57(2):268-269.   Published online February 2, 2024
        DOI: https://doi.org/10.5946/ce.2023.275
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      A remnant cystic duct presenting as a duodenal subepithelial tumor
      Image Image
      Fig. 1. Endoscopic ultrasonography (EUS) findings. (A) A 1-cm-sized subepithelial lesion covered by normal duodenal mucosa is observed in the anterior wall of the duodenal bulb. (B, C) EUS using a 20-MHz catheter probe reveals a 0.8×0.6 cm-sized anechoic lesion with hyperechoic suture material (arrow) outside the duodenal wall. (D) Conventional EUS (7.5 MHz) reveals that the anechoic lesion was connected to the common bile duct and had no Doppler flow (arrow).
      Fig. 2. Abdominal computed tomography reveals a remnant cystic duct with suture material (arrows). (A) Transverse section view. (B) Coronal section view.

      Fig. 1.

      Fig. 2.

      A remnant cystic duct presenting as a duodenal subepithelial tumor
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