Introduction
Argon plasma coagulation (APC) has proven effective for trimming metallic stents [1]. We report a case in which APC was utilized to address basket-stone impaction resulting
from inflammatory stricture of the bile duct ([Fig. 1]).
Fig. 1 Fluoroscopic image showing inflammatory stricture of the distal bile duct (blue arrow).
Case report
A 67-year-old man was admitted with cholangitis after undergoing endoscopic treatment
for choledocholithiasis at another hospital. The stones had a maximum diameter of
9 mm, which was not particularly large. During the procedure, a biliary extraction
basket with eight wires became stuck in the distal bile duct. After several unsuccessful
attempts to manage the basket-stone impaction, an endoscopic nasobiliary tube was
inserted alongside the shaft of the basket catheter, and the patient was transferred
to our hospital ([Fig. 2]).
Fig. 2 Fluoroscopic image showing the stuck basket and the endoscopic nasobiliary tube.
Because the basket was exposed to the duodenal lumen, we used APC (VIO300D; 40 W flow
rate 1.8 L/min; ERBE, Germany) to cut the basket’s metallic wires one by one ([Video 1]) ([Fig. 3]
a, [Fig. 3]
b, [Fig. 3]
c). We began with a setting of 40 W for safety and continued at this setting, owing
to its effectiveness. After cutting six of the basket’s eight wires, the catheter
could be pulled to remove the entire basket ([Fig. 4]). Subsequently, we placed an endoscopic biliary stent, completing the first session.
After 2 months, an endoscopic papillary large balloon dilation was performed to treat
the inflammatory stricture before stone removal. We successfully removed the remaining
stones using a mechanical lithotripter ([Fig. 5]).
Argon plasma coagulation was utilized to address basket-stone impaction resulting
from the inflammatory stricture of the bile duct.Video 1
Fig. 3
a Endoscopic image showing the basket and endoscopic
nasobiliary tube exposed in the duodenum lumen. b Endoscopic
image during APC for stone-impacted basket catheter. c
Fluoroscopic image during APC for stone-impacted basket catheter.
Fig. 4 The removed basket.
Fig. 5 Fluoroscopic image showing complete removal of the remaining stones.
A key aspect of this method was maintaining control of the catheter shaft while cutting.
Monitoring the traction force allowed us to avoid mucosal injury and precisely cut
the target wire. Leaving some wires uncut facilitated basket removal by manually pulling
on the catheter shaft [2]
[3]. Cutting a wire of a basket with APC can be safe and effective when wire is exposed
to the duodenal lumen.
Bibliographical Record
Tomona Sakurai, Kazuya Sumi, Yuki Kawasaki, Hisaki Kato, Jun Ushio, Takayoshi Ito,
Haruhiro Inoue. Rescue of a biliary extraction basket impaction using argon plasma
coagulation. Endosc Int Open 2025; 13: a25003862.
DOI: 10.1055/a-2500-3862
