Cholangioscopy and electrohydraulic lithotripsy in the management of fistulated pancreatic duct stones

摘要

Fig. 2 Endoscopic retrograde cholangiopancreatography showing heavily calcified stones within the extrahepatic ducts. Stone extraction was unsuccessful with the extraction balloon and mechanical lithotriptor. A plastic pigtail biliary stent was deployed to assist biliary drainage. Subsequent magnetic resonance cholangiopancreatography (MRCP) showed continuity of the pancreatic duct and bile duct, suggesting the presence of a pancreatobiliary fistula ([Fig. 3]). Fig. 3 Magnetic resonance cholangiopancreatography confirming the presence of a pancreatobiliary fistula. The patient underwent a further ERCP with peroral transpapillary cholangioscopy ([Video 1]). Direct visualization demonstrated a pancreatobiliary fistula associated with the lower bile duct, as well as the presence of white, heavily calcified stones within the extrahepatic bile ducts. Cholangioscopic assessment of the pancreatic duct through the fistula revealed intraluminal papillary projections, consistent with an intraductal papillary mucinous neoplasm (IPMN). Intraductal electrohydraulic lithotripsy (EHL) and subsequent balloon trawl were used to clear the biliary stones. Biopsies confirmed the presence of an IPMN. Video 1 Cholangioscopy and electrohydraulic lithotripsy are performed to treat fistulated pancreatic duct stones. Georg Thieme Verlag. Please enable Java Script to watch the video.Download Pancreatobiliary fistulas associated with pancreatic IPMN have previously been described; however, we believe this is the first video-reported case of fistulated pancreatolithiasis that was treated with EHL.Endoscopy_UCTN_Code_CCL_1AZ_2AMEndoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.