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• W2009951799 abstract "A 27-year-old woman with a prior cholecystectomy underwent endoscopic retrograde cholangio pancreatography (ERCP) for abdominal pain and choledocholithiasis. After biliary sphincterotomy, a flower basket was used to grasp and retrieve a 15-mm mid–common bile duct (CBD) stone. However, the flower basket became impacted in the CBD (Figure A). Then, the distal CBD was dilated using a 15-mm CRE balloon dilator (Boston Scientific, Natick, MA). Despite this, the basket could not be pulled out. The outer plastic sheath of the basket was removed and a Soehendra mechanical lithotripter then was inserted alongside the basket wires into the CBD and mechanical lithotripsy (Cook Medical, Winston-Salem, NC) of the stone was attempted. The lithotripter also became impacted in the CBD over the basket (Figure B) and could not be pulled out. The presence of the impacted basket, lithotripter, and wires in the CBD precluded placement of a stent, but there was good bile drainage seen. Because of the prolonged efforts and complexity, it was elected to terminate the procedure. The basket and lithotripter wires were cut and secured at the patient’s mouth with an adhesive tape. The patient was placed on a liquid diet along with broad-spectrum antibiotics for prophylaxis against cholangitis. ERCP was repeated after 3 days and attempts to drag the impacted devices and stone with an extraction balloon were unsuccessful. Electrohydraulic lithotripsy (EHL) then was performed using Spyglass (Boston Scientific) and the stone was fragmented. The impacted basket and lithotripter could be pulled out of the bile duct by using a rat-tooth forceps, passed under endoscopic and fluoroscopic guidance (Figure C). An extraction balloon was swept to clear the residual stone fragments. A 10F 10-cm plastic stent was inserted temporarily for 4 weeks to ensure biliary drainage and the patient did well. ERCP with biliary sphincterotomy and stone extraction remains the standard of care for choledocholithiasis. Common complications include pancreatitis, bleeding, cholangitis, and perforation. Entrapment of the stone retrieval baskets in the CBD is a very rare complication. Endoscopic mechanical lithotripsy has been reported as a plausible management strategy in such situations.1Rajeev P. Goh K.l. Retrieval of an impacted Dormia basket and stone in situ using a novel method.Gastrointest Endosc. 2000; 51: 504-506Google Scholar Our case was unique because it not only reports a concurrence of 2 rare complications (ie, impaction of both the retrieval basket and a mechanical lithotripter) but also the failure of previously described salvage methods. Management options for such situations include surgical exploration of the bile duct vs a conservative management strategy with antibiotics and repeat attempts by ERCP.2Maple J.T. Baron T.H. Biliary-basket impaction complicated by in vivo traction-wire fracture: report of a novel management approach.Gastrointest Endosc. 2006; 64: 1031-1033Google Scholar In a conservative strategy, it is important to ensure good biliary drainage by placement of a temporary stent along with administration of antibiotics for the prevention of cholangitis and sepsis.3Lambert M.E. Betts C.D. Hill J. et al.Endoscopic sphincterotomy: the whole truth.Br J Surg. 1991; 78: 473-476Google Scholar Based on this case report, we suggest endoscopists use EHL as the next step for an entrapped stone retrieval basket or a mechanical lithotripter. Cholangioscopy with EHL or laser lithotripsy might be preferable to mechanical lithotripsy, especially for large hard stones such as pigment stones." @default.
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• W2009951799 date "2015-02-01" @default.
• W2009951799 modified "2023-10-16" @default.
• W2009951799 title "Technique for Retrieving Basket and Lithotripter During Endoscopic Retrograde Cholangiopancreatography" @default.
• W2009951799 cites W1985432943 @default.
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• W2009951799 doi "https://doi.org/10.1016/j.cgh.2014.08.014" @default.
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