A 61-year-old man with symptoms of chills and high fever had undergone pancreatoduodenectomy
in 2009 because of pancreatic serous cystadenoma. Magnetic resonance cholangiopancreatography
suggested stones in the common and left hepatic duct ([Fig. 1]). The type of the gastrointestinal reconstruction was ascertained from surgical
records, and we used a cap-assisted colonoscope (PCF-PQ260; Olympus Medical Systems,
Tokyo, Japan) for endoscopic retrograde cholangiopancreatography (ERCP). The removal
of the common hepatic duct stones followed the ERCP sequence: intubation to the afferent
limb, biliary cannulation, balloon dilation of the distal bile duct, and balloon-assisted
stone extraction. When the left intrahepatic duct stones could not be removed using
to this method, we carried out wire-guided cannulation using an improved single-lumen
stone extraction basket, in which a hole was made with the tip of a needle ([Fig. 2]) to allow it to be advanced over the guidewire ([Fig. 3]) into the desired segmental duct ([Fig. 4]). The stones were engaged and dragged into the intestinal tract without removing
the guidewire ([Video 1]). This process was repeated until complete removal of the stones was accomplished.
The patient was discharged on the 2nd day after the operation. During the following
3 weeks, there were no abnormal symptoms.
Fig. 1 Magnetic resonance cholangiopancreatography suggested stones in the common and left
hepatic duct (red arrow) with proximal intrahepatic bile duct dilatation.
Fig. 2 The 7-Fr catheter of the basket (Vedkang; Jiangsu, China) was dug out with 1.2-mm
needle from a 20-ml sterile syringe.
Fig. 3 The catheter was passed over a 0.035-inch guidewire (Vedkang) and advanced into the
endoscope.
Fig. 4 The wire-guided basket placed into the segment and opened with the guidewire in the
desired intrahepatic duct.
Video 1 Extraction of left main intrahepatic duct stones using an improved wire-guided basket.
Endoscopic extraction of intrahepatic duct stones with conventional stone retrieval
baskets is sometimes difficult [1], especially in patients with surgically altered anatomy [2]. Understanding the reconstruction that has been carried out helps endoscopists to
select the appropriate endoscope and achieve biliary access [3]
[4]. Intrahepatic duct stone removal can be difficult because of altered anatomy as
well as the limitations of stone extraction devices [2]. We offer here an improvement of the single-lumen-type basket that can be used in
combination with a guidewire; it is not as rigid as the double-lumen or any other
attached types [5]. Its use in our center proves that it is safe, and we think it is an easy and cheap
alternative for use in developing countries in patients with intrahepatic duct stones.
Prospective randomized controlled trials are warranted in terms of safety, efficacy,
and cost effectiveness.
Endoscopy_UCTN_Code_TTT_1AR_2AK
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