A 72-year-old man who presented with fever, chills, abdominal pain, and jaundice was
admitted to the hospital. He had a history of bile duct cancer and underwent laparoscopic
gallbladder-jejunostomy for biliary obstruction two years ago. Two ventricular drainage
catheters with a diameter of 12 Fr were placed through the gallbladder into the right
and left intrahepatic bile ducts. Preoperative magnetic resonance cholangiopancreatography
(MRCP) revealed there were filling defects in the common hepatic duct and the upper
end of the common bile duct, suspected to be stones, and the catheterization shadows
from the gallbladder to the common bile duct were observable ([Fig. 1 ]). The decision to perform endoscopic retrograde cholangiopancreatography (ERCP)
for stone removal was made after a multidisciplinary discussion.
Fig. 1 Preoperative magnetic resonance cholangiopancreatography (MRCP) revealed the shadow
of the internal duct associated with the gallbladder (indicated by the yellow arrow).
During the stone extraction process, it was observed that the basket (FG-V432P; Olympus,
Tokyo, Japan) was impacted by the drainage catheter ([Fig. 2 ]). Following exploration with a choledochoscope (M00546600; Boston Scientific,
Marlborough, Massachusetts, USA), we used biopsy forceps (M00546470; Boston Scientific)
to
gradually sever the drainage catheter, successfully resolving the impaction ([Video 1 ]). Subsequently, a nasal biliary catheter (L14725D; Leo Medical Co., Ltd., Changzhou,
China) was inserted into the left intrahepatic bile duct to drain the bile and contrast
medium.
Four days post-operation, during gastroscopy, the nasal biliary catheter was transected
at the
duodenal bulb using an endoscopic scissor (JHY-FG-23-230-A6; Jiuhong Medical, Changzhou,
China),
converting its remainder into a stent. Bile drainage proceeded smoothly thereafter
([Fig. 3 ]).
Fig. 2 X-ray imaging revealed the impaction of the basket (indicated by the white arrow),
along with the cross-section of a drainage catheter (indicated by the blue arrow).
Fig. 3
a Gastroscopy revealed that the nasal bile duct was not displaced. b The nasal bile duct was subsequently severed. c The bile drainage remained unobstructed.
A case of special basket impaction removal during endoscopic retrograde cholangiopancreatography
using biopsy forceps under choledochoscope.Video 1
Currently, in contrast to stone-related impaction, those associated with drainage
catheters cannot be resolved using choledochoscope laser lithotripsy or extracorporeal
shock wave lithotripsy (ESWL) [1 ]
[2 ]. The application of argon plasma coagulation (APC) for cutting the basket may lead
to electrical burns, whereas surgical intervention tends to be more traumatic [3 ]. In this case, we cut off the drainage catheter under choledochoscope by using biopsy
forceps, successfully released the impaction, and retrieved the basket without any
adverse events. This may be an effective measure for drainage catheter-related impaction.
Endoscopy_UCTN_Code_CPL_1AK_2AF
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