VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE

Rescue of basket-impacted stone by use of electrohydraulic lithotripsy under cholangioscopy

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

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. Herein, we describe a successful case in which a basket-impacted stone was released by use of transpapillary cholangioscopic electrohydraulic lithotripsy (EHL). 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. 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 This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.

376 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 3 : 2014

again. Therefore, we performed transpapillary EHL with the use of a mother-baby type of cholangiosope (Fig. 1). Eventually, lithotripsy was successfully performed without any adverse events, and all of the stone fragments were removed by standard duodenoscopy (Video 1, available online at www.giejournal.org). 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. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Takayoshi Tsuchiya, MD, Takao Itoi, MD, Atsushi Sofuni, MD, Shujiro Tsuji, MD, Nobuhito Ikeuchi, MD, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

http://dx.doi.org/10.1016/j.gie.2013.11.009

www.giejournal.org

Rescue of basket-impacted stone by use of electrohydraulic lithotripsy under cholangioscopy.

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