Successful extraction of hepatic duct calculus using retrieval basket under cholangioscopic guidance

Hepatolithiasis or intrahepatic duct calculi is one of the most complex stone diseases as it poses a great challenge in treatment and also has strong propensity for recurrence. It may be complicated by bile duct strictures, cholangiolytic abscesses, and cholangiocarcinoma [1]. The main endpoint of the treatment for hepatolithiasis would be stone clearance, stricture correction, and restoration of biliary drainage [2].

A 27-year-old woman was referred to our department for right upper quadrant pain of the abdomen and fever for 3 days. Patient was hemodynamically stable. Her blood investigations were unremarkable except for elevated liver enzymes (AST 69 IU/L, ALT 71 IU/L, and ALP 354 IU/L). Magnetic resonance cholangiopancreatography showed one calculus measuring 6 mm in the right anterior sectoral duct with upstream biliary dilatation and another small calculus in the distal bile duct ([Fig. 1]).

Fig. 1 Magnetic resonance cholangiopancreatography revealed one calculus in the right anterior sectoral duct (arrow) and another small calculus in the distal bile duct (arrow head).

Endoscopic retrograde cholangiopancreatography (ERCP) revealed a filling defect in the lower end of the bile duct and in the right hepatic duct. The sludge material came out after biliary sphincterotomy. A cholangioscope (SpyGlass DS; Boston Scientific, Natick, Massachusetts, USA) was inserted into the bile duct ([Video 1]) and a stone was seen in one of the branches of the hepatic duct ([Fig. 2 a]). The stone was captured using the SpyGlass retrieval basket (Boston Scientific) after negotiating the guidewire ([Fig. 2 b]). Finally, the stone was removed from the bile duct under direct visualization by cholangioscope ([Fig. 2 c]).

Video 1 Retrieval of hepatic duct calculus using a retrieval basket.

Fig. 2 a A stone seen in one of the branches of the hepatic duct. b Retrieval basket was used to capture the stone. c Stone was removed from the bile duct under direct visualization by cholangioscope.

There are only few cases of bile duct stone extraction using this retrieval basket reported in the literature [3]. Extraction of hepatic duct stones using a retrieval basket is quite challenging and reports of such cases are scarce.

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Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022

• References

• 1 Uenishi T, Hamba H, Takemura S. Outcomes of hepatic resection for hepatolithiasis. Am J Surg 2009; 198: 199-202
• 2 Huang ZQ, Xu LN, Tao YA. et al. Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases. Chin Med J (Engl) 2009; 122: 2268-2277
• 3 Han S, Shah RJ. Cholangioscopy-guided basket retrieval of impacted stones. VideoGIE 2020; 5: 387-388