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
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REFERENCES
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.
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.
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.