ERCP management of cystic duct stones with a rare anatomic variant in octogenarian: a case report

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a critical therapeutic modality for bile duct stones; however, cases of cystic duct stones (CDS) managed by ERCP alone are rarely reported. Herein, we present a rare case of an octogenarian patient with an anatomic variation consisting of low and left-sided insertion of the cystic duct (CD) in whom both bile duct stones and CDS were successfully treated using ERCP. Case presentation An 82-year-old male presented to our hospital with an acute epigastric pain associated with fever and chills. Diagnostic imaging revealed multiple bile duct stones and CDS, along with an anatomical variant of the low and left-sided insertion of the CD. The patient declined to undergo laparoscopic cholecystectomy (LC) with laparoscopic common bile duct exploration (LCBDE) because of concerns about surgical risks. All stones were successfully removed via ERCP, with preservation of the gallbladder function. The patient experienced no postoperative complications, and no stone recurrence was detected during the 1-year follow-up period. Conclusion This case demonstrates that an ERCP-only approach represents a safe and effective therapeutic strategy for patients with biliary anatomic variations complicated by complex stone disease, particularly in the oldest-old (≥80 years) patients who are ineligible for laparoscopic surgery. The postoperative recurrence rate of biliary stones remained high in this patient population. In such cases, a repeat ERCP is a viable and reasonable therapeutic option.