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

摘要

Basket impaction of a bile duct stone is a well-known problem occurring during endoscopic transpapillary litho-tripsy. 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 x 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 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).