The management of choledocholithiasis can be a challenging problem depending on the
number, size, and location of the stones. Therapeutic endoscopic retrograde cholangiopancreatography
(ERCP) has been the standard of care for decades. Various tools and techniques have
been used during ERCP including, but not limited to, sphincteroplasty, extraction
balloon, mechanical lithotripsy with trapezoid basket, extracorporeal shockwave lithotripsy,
and direct cholangioscopy with lithotripsy. Residual stones may remain even after
adequate balloon sweeps and negative occlusion cholangiogram, especially if the bile
duct is dilated and stones are small, escaping the balloon sweeps [1]. Direct cholangioscopy has proven to be a useful tool in directly visualizing the
ducts for any residual stones in order to achieve complete clearance [2]
[3].
The SpyGlass retrieval basket (Boston Scientific, Marlborough, Massachusetts, USA)
is one of the new tools that can be used to extract stones found during cholangioscopy.
We present a video case of choledocholithiasis in which the SpyGlass retrieval basket
was used to extract the residual stones in the bile duct ([Video 1]).
Video 1 Novel SpyGlass retrieval basket (Boston Scientific, Marlborough, Massachusetts, USA)
for the retrieval of choledocholithiasis. Source for stent: Boston Scientific.
A 60-year-old woman with no significant medical problems was referred to us for intermittent
right upper quadrant abdominal pain and multiple retained choledocholithiasis. She
had no symptoms or signs of cholangitis. ERCP was performed. Initial cholangiogram
showed a dilated bile duct with multiple small and large filling defects in most of
the common bile duct and common hepatic duct, consistent with the presence of stones.
Sphincterotomy was performed and multiple large stones were extracted using a 12-mm
extraction balloon catheter. As we suspected retained stones, SpyGlass cholangioscopy
was performed, which showed one residual stone in the cystic duct and two residual
stones in the left hepatic duct. A SpyGlass retrieval basket was then used and all
the stones were extracted.
No adverse events were reported. The patient was discharged home in a stable condition.
Endoscopy_UCTN_Code_TTT_1AR_2AH FB
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
