Post written by Samuel Han, MD, MS, from The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

We describe a case of pancreatoscopy-guided removal of a pancreatic duct stone. As electrohydraulic lithotripsy (EHL) was unsuccessful in fragmenting the large pancreatic duct stone, we used a cholangiopancreatoscopy-specific basket device to capture the stone.

During removal of the basket, however, the basket became impacted within the pancreatic duct. We were eventually able to pull with enough force that the basket separated from its catheter, allowing us to perform pancreatoscopy side-by-side the entrapped basket. This allowed us to conduct salvage EHL of the impacted stone, which successfully fragmented the stone and allowed us to free the basket.  

We believe it is important to showcase this video because it describes a salvage technique to free an impacted basket. An entrapped basket is one of the primary reasons why endoscopists rarely use baskets for stone removal nowadays, but baskets remain helpful tools in stone removal, particularly when other techniques fail.

In using the cholangiopancreatoscopy-specific device, we believe this technique can be particularly useful, as the catheter of the device can always be manually cut, allowing for side-by-side cannulation of the duct using the cholangioscope or pancreatoscope.  

We hope this technique gives endoscopists another tool to nonsurgically manage impacted stones. We also want to call attention to, interestingly, how once the stone was entrapped with the basket, EHL was very successful in fragmenting the stone despite previously being unsuccessful.

Cholangiopancreatoscopy-guided retrieval basket wires upon removal after impaction.

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