Rescue of basket-impacted stone

Dr. Takayoshi Tsuchiya Takayoshi Tsuchiya, MD, PhD from the Tokyo Medical University Hospital in Tokyo, Japan presents this video case “Rescue of basket-impacted stone by use of electrohydraulic lithotripsy under cholangioscopy (with videos)” from the VideoGIE section.

Basket impaction of a bile duct stone is a well-known problem occurring during endoscopic transpapillary lithotripsy. Generally, it is resolved by a transoral endotripter. However, even if the endotripter is used, we sometimes encounter failed cases in which the wires break because of the hardness of the stone.

In such a case, for the rescue methods, extracorporeal shock wave lithotripsy and laser or electrohydraulic lithotripsy (EHL) under the guidance of conventional mother-baby cholangioscopy can be considered.

Herein, we describe a successful case in which a basket-impacted stone was released by use of transpapillary cholangioscopic EHL.

March_Tsuchiya_figureFigure 1. A, Cholangioscopic image of impacted bile duct stone. B, Complete lithotripsy was achieved by electrohydraulic lithotripsy under cholangioscopy.

A 77-year-old woman had obstructive jaundice caused by a large (25 mm × 30 mm) bile duct stone. After endoscopic sphincterotomy, lithotripsy was performed with a mechanical lithotripter (ML). However, the basket wires at the distal portion were broken because of the hard stone, resulting in basket impaction. Subsequently, release of the basket impaction was attempted with a transoral endotripter; however, basket wires at the distal portion broke again. Therefore, we performed transpapillary EHL (Fig. 1,2) with the use of a mother-baby type of cholangiosope (Fig. 3). Eventually, lithotripsy was successfully performed (Fig. 4) and we can removed broken ML using forceps without any adverse events. Finally, all of the stone fragments were removed by standard ERCP.

Apart from emergency operations, extracorporeal shock wave lithotripsy has often been used to release basket impaction in such a situation. We propose, on the basis of our case, that transpapillary EHL under cholangioscopy may be another option for releasing basket impactions.

Find more VideoGIE cases here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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