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• W3208300352 abstract "Introduction: Common bile duct (CBD) stones are prevalent in up to 20% of patients with gallstones and can cause various clinical manifestations ranging from biliary colic to gallstone pancreatitis and sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography (ERCP), but larger CBD stones are difficult to remove using conventional endoscopic methods. There are various advanced techniques for gallstone removal such as cholangioscopy with lithotripsy but this is technically demanding and has limited availability. We report a case of a large CBD stone that was successfully removed using dilation-assisted stone extraction (DASE) method with a stone retrieval basket. Case Description/Methods: A 78-year-old man with no significant past medical history presented to a local hospital with 5 days of worsening right sided abdominal pain with associated nausea and vomiting. He was hemodynamically stable and afebrile at the time of presentation. Initial lab work up revealed total bilirubin 12 mg/dl, direct bilirubin 10.2 mg/dl, AST 123 IU/L, ALT 129 IU/L, alkaline phosphatase of 261 IU/L, Lipase 4444 U/L, and WBC count of 15 B/L. CT scan revealed a 5 cm x 2 cm stone in the common bile duct with dilation up to 3.5cm. Patient was found to have molymicrobial bacteremia and was transferred to our hospital for ERCP. ERCP was performed with 15mm biliary sphincterotomy and a proportionate biliary orifice dilation to 18mm (the size of distal duct). Oblong shaped stone was successfully removed with Trapezoid stone retrieval basket using it as a sweeping tool rather than a fragmenting tool. After stone extraction into the duodenum, stone was fragmented with a snare and removed from duodenum with the help of rescue net. Patient was discharged home the day after ERCP without any complications. Discussion: Stone retrieval baskets are safe and efficient way of removing large bile duct stones. Adequate dilation of biliary orifice is key to successful extraction of large stones. Significantly larger size stones should be retrieved from GI tract after extraction from bile duct to avoid gallstone ileus or intestinal obstruction. Successful retrieval of stones during the same session can prevent need for further endoscopic interventions and unnecessary risk associated with more invasive procedures." @default.
• W3208300352 created "2021-11-08" @default.
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• W3208300352 date "2021-10-01" @default.
• W3208300352 modified "2023-09-27" @default.
• W3208300352 title "S3542 Large Bile Duct Stone Extraction Using Stone Retrieval Basket After Generous Sphincterotomy and Proportionate Dilation of Biliary Orifice" @default.
• W3208300352 doi "https://doi.org/10.14309/01.ajg.0000787700.18952.60" @default.
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