Jörg G. Albert, MD, from the Department of Medicine I, Johann Wolfgang Goethe-University, in Frankfurt, Germany shares this VideoGIE case, “‘Cutting the wire’ as a troubleshooter for a Dormia basket impacted in the common bile duct.”

Incarceration of a bile duct stone may be a challenge for the endoscopist – but to jam a Dormia basket within the common bile duct (CBD) is a major complexity. However, few rescue techniques might work, among them one of the most elegant techniques are described in this video case.

Here, the basket’s central lead wire burst about 15 cm away from the basket, and stone and basket had to be left in the CBD. Re-passage of the scope was accomplished with use of a lithotripter basket to entrap the left behind basket and to crush the stone and remove both baskets, but the incarcerated basket completely blocked the entrance of the CBD. Therefore, we used argon plasma coagulation (APC) to cut 3 of the 6 wires of the basket that partially protruded from the papillary orifice, and thus easily removed the basket.

This procedure adds to the few rescue techniques on hand in a intricate situation that might even happen to a very experienced endoscopist.

Endoscopic cutting and tailoring of uncovered metallic prosthesis, by means of APC, has been reported to be feasible, effective, and safe. From a technical point of view, the melting point of steel depends on the alloy; steel often melts at around 1370 degrees C (2500°F), Nitinol around 1300 deg. C (2370°F). Forced APC may attain these high temperatures.

In our experience of a small case series, cutting Nitinol stents is feasible and without negative sequel for the patient. This is our first experience with cutting wires of a Dormia basket, thereby elegantly freeing an incarcerated stone retrieval basket.

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