{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T13:24:03Z","timestamp":1773667443614,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background\/Objectives: Post-cholecystectomy syndrome (PCS) remains diagnostically challenging due to overlapping biliary and non-biliary causes. This study aimed to evaluate whether common bile duct (CBD) diameter measured by MRCP can serve as a practical triage parameter in symptomatic PCS patients and to define a data-supported threshold for predicting clinically relevant biliary pathology. Secondary objectives included assessing correlations between MRCP findings and upper endoscopic features. Methods: In this retrospective single-center study, symptomatic adults undergoing upper endoscopy and MRCP were analyzed. Demographic, clinical, biochemical, radiologic, and endoscopic variables were recorded. Diagnostic performance was assessed using ROC analysis, and independent predictors of biliary dilatation were evaluated with multivariable logistic regression. Results: We analyzed 141 symptomatic post-cholecystectomy patients (mean age 58.2 \u00b1 16.3 years; 67.4% female; median time since surgery 18 [9\u201336] months). Major symptoms: abdominal pain 84.9%, dyspepsia\/bloating 47.5%, nausea\/vomiting 22.3%, diarrhea 15.1%. CBD diameter measurements were available in the MRCP subgroup (n = 45); ERCP was performed selectively (n = 12). MRCP findings: CBD \u2265 7 mm 31.9%, biliary dilatation 14.9%, stricture 2.8%, suspected Oddi dysfunction 11.3%, postoperative complications 39.7%. Endoscopy: mucosal inflammation 91.5%; normal 8.5%. Significant correlations included CBD diameter vs. mucosal inflammation (r = 0.32, p = 0.001), dilatation vs. bile reflux (r = 0.28, p = 0.004), and Oddi dysfunction vs. papillary edema (r = 0.41, p = 0.001). CBD diameter showed the best diagnostic performance (AUC 0.82, 95% CI 0.74\u20130.90; cut-off \u2265 8.0 mm; sensitivity 78.3%; specificity 81.5%; p &lt; 0.001). In multivariable analysis, age independently predicted biliary dilatation (OR 1.05 per year; 95% CI 1.01\u20131.09; p = 0.007). Conclusions: In symptomatic post-cholecystectomy patients, MRCP-measured CBD diameter provides a useful metric for risk stratification, with a threshold of \u22658 mm identifying patients more likely to harbor biliary pathology. These findings support a structured diagnostic approach that prioritizes noninvasive imaging while reserving ERCP for selected cases. Further prospective validation is warranted.<\/jats:p>","DOI":"10.3390\/tomography12030039","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T11:13:14Z","timestamp":1773659594000},"page":"39","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-Modal Assessment of Post-Cholecystectomy Symptoms: Integrating MRCP Metrics with Upper Endoscopy"],"prefix":"10.3390","volume":"12","author":[{"given":"Davut Unsal","family":"Capkan","sequence":"first","affiliation":[{"name":"Department of Radiology, Medical Point Hospital, 27060 Gaziantep, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3921-7675","authenticated-orcid":false,"given":"Ibrahim Tayfun","family":"Sahiner","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Medical Point Hospital, 27060 Gaziantep, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.suc.2021.06.012","article-title":"Management of Postcholecystectomy Complications","volume":"101","author":"Feng","year":"2021","journal-title":"Surg. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s00464-012-2516-9","article-title":"Persistent and de novo symptoms after cholecystectomy: A systematic review of cholecystectomy effectiveness","volume":"27","author":"Lamberts","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.surg.2023.06.010","article-title":"Persistent and new-onset symptoms after cholecystectomy in patients with uncomplicated symptomatic cholecystolithiasis: A post hoc analysis of 2 prospective clinical trials","volume":"174","author":"Thunnissen","year":"2023","journal-title":"Surgery"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1136\/flgastro-2019-101190","article-title":"How to manage postcholecystectomy abdominal pain","volume":"12","author":"Bekkali","year":"2021","journal-title":"Frontline Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20230067","DOI":"10.1515\/sjpain-2023-0067","article-title":"The incidence of post cholecystectomy pain (PCP) syndrome at 12 months following laparoscopic cholecystectomy: A prospective evaluation in 200 patients","volume":"24","author":"Lee","year":"2024","journal-title":"Scand. J. Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2496408","DOI":"10.1080\/07853890.2025.2496408","article-title":"Clinical perspectives on post-cholecystectomy syndrome: A narrative review","volume":"57","author":"Nam","year":"2025","journal-title":"Ann. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"58","DOI":"10.21037\/tgh.2019.11.08","article-title":"Post-cholecystectomy syndrome: A retrospective study analysing the associated demographics, aetiology, and healthcare utilization","volume":"6","author":"Saleem","year":"2021","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kegn\u00e6s, M., Novovic, S., and Shabanzadeh, D.M. (2023). Dysfunction of Biliary Sphincter of Oddi\u2014Clinical, Diagnostic and Treatment Challenges. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144802"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1053\/j.gastro.2016.02.033","article-title":"Gallbladder and Sphincter of Oddi Disorders","volume":"150","author":"Cotton","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e13053","DOI":"10.1111\/nmo.13053","article-title":"What\u2019s new in Rome IV?","volume":"29","author":"Tack","year":"2017","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.3748\/wjg.v21.i11.3351","article-title":"Diagnostic value of magnetic resonance cholangiopancreatography in choledocholithiasis","volume":"21","author":"Chen","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/jcu.23136","article-title":"Diagnostic accuracy of ultrasonography compared with magnetic resonance cholangiopancreatography in the detection of choledocholithiasis","volume":"50","author":"Samara","year":"2022","journal-title":"J. Clin. Ultrasound"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6525","DOI":"10.1007\/s00464-025-12054-z","article-title":"Suspected common bile duct stones: Which test is best?","volume":"39","author":"Varone","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3348\/jksr.2018.78.3.147","article-title":"Role of Magnetic Resonance Cholangiopancreatography in Evaluation of Choledocholithiasis in Patients with Suspected Cholecystitis","volume":"78","author":"You","year":"2018","journal-title":"J. Korean Soc. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kumar, A., Mohanty, N.R., Mohanty, M., and Dash, S. (2023). Comparison of MRCP and ERCP in the evaluation of common bile duct and pancreatic duct pathologies. Front. Med. Technol., 5.","DOI":"10.3389\/fmedt.2023.946555"},{"key":"ref_16","first-page":"e34484","article-title":"Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison With Endoscopic Retrograde Cholangiopancreatography for Detection of the Etiology of Obstructive Jaundice","volume":"15","author":"Isram","year":"2023","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.3748\/wjg.v25.i29.4019","article-title":"Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment","volume":"25","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.gtc.2015.10.009","article-title":"The Role of Endoscopic Retrograde Cholangiopancreatography in Management of Pancreatic Diseases","volume":"45","author":"Riff","year":"2016","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4253\/wjge.v11.i3.219","article-title":"Endoscopic retrograde cholangiopancreatography, lights, and shadows: Handle with care","volume":"11","author":"Salerno","year":"2019","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1148\/rg.210106","article-title":"Multimodality Imaging of Cholecystectomy Complications","volume":"42","author":"Patel","year":"2022","journal-title":"RadioGraphics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4589","DOI":"10.1007\/s00261-025-04863-6","article-title":"Pancreatitis-related benign biliary strictures: A review of imaging findings and evolving endoscopic management","volume":"50","author":"Awali","year":"2025","journal-title":"Abdom. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1097\/00000478-199610000-00001","article-title":"Classification and Grading of Gastritis","volume":"20","author":"Dixon","year":"1996","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1136\/gut.45.2.172","article-title":"Endoscopic assessment of oesophagitis: Clinical and functional correlates and further validation of the Los Angeles classification","volume":"45","author":"Lundell","year":"1999","journal-title":"Gut"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4278373","DOI":"10.1155\/2019\/4278373","article-title":"Etiologies of Long-Term Postcholecystectomy Symptoms: A Systematic Review","volume":"2019","author":"Latenstein","year":"2019","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ijsu.2009.10.008","article-title":"Postcholecystectomy syndrome (PCS)","volume":"8","author":"Jaunoo","year":"2010","journal-title":"Int. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1089\/lap.2013.0546","article-title":"Laparoscopic Versus Endoscopic Management of Choledocholithiasis in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-analysis","volume":"24","author":"Liu","year":"2014","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3792","DOI":"10.1007\/s12325-024-02949-z","article-title":"One-Stage Intraoperative ERCP combined with Laparoscopic Cholecystectomy Versus Two-Stage Preoperative ERCP Followed by Laparoscopic Cholecystectomy in the Management of Gallbladder with Common Bile Duct Stones: A Meta-analysis","volume":"41","author":"Zhang","year":"2024","journal-title":"Adv. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4174\/jkss.2012.83.2.97","article-title":"Common bile duct dilatation after cholecystectomy: A one-year prospective study","volume":"83","author":"Park","year":"2012","journal-title":"J. Korean Surg. Soc."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/12\/3\/39\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T12:17:26Z","timestamp":1773663446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/12\/3\/39"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["tomography12030039"],"URL":"https:\/\/doi.org\/10.3390\/tomography12030039","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}