Basket impaction is a significant complication of pancreatic stone extraction. There
have been a few reports highlighting the usefulness of endoscopic papillary large
balloon dilation (EPLBD) in the pancreatic duct for managing large pancreatic stones
[1]
[2]. Here we report a case of successful resolution of basket impaction during pancreatic
stone extraction using EPLBD.
A 65-year-old man with chronic alcoholic pancreatitis underwent repeated endoscopic
pancreatic stenting (EPS) for pancreatic duct stenosis and pancreatic stone extraction.
Before admission, contrast-enhanced computed tomography revealed dilatation of the
main pancreatic duct (MPD) and multiple pancreatic stones around the EPS ([Fig. 1]).
Fig. 1 Contrast-enhanced computed tomography revealed the dilatation of the main pancreatic
duct and multiple pancreatic stones around the endoscopic pancreatic stenting.
Endoscopic retrograde cholangiopancreatography was performed as a substitute for EPS.
After EPS removal, pancreatography revealed multiple defects in the dilated MPD without
significant stenosis. As these defects were suspected to represent protein plugs and
small stones, stone extraction was performed using an eight-wire basket catheter (Medi-Globe
8-Wire Nitinol Basket; Medico’s Hirata Inc., Osaka, Japan). However, an unexpectedly
large number of stones were captured, leading to basket impaction at the papilla ([Fig. 2]).
Fig. 2
a Endoscopic retrograde pancreatography revealed multiple defects in the main pancreatic
duct. b Using an eight-wire basket catheter, an unexpectedly large number of stones were
captured, leading to basket impaction at the papilla (yellow arrowhead).
To resolve the impaction, the basket catheter wire was cut outside the scope, and
the outer sheath was removed prior to performing EPLBD adjacent to the basket with
a balloon catheter (Giga II balloon, 10–12 mm; Century Medical Inc., Tokyo, Japan).
The balloon was inflated to a pressure of 4 atm (12 mm) and maintained for 1 min.
During balloon deflation, the basket catheter was gently withdrawn, with successful
retrieval of the impacted basket and stones without procedure-related complications
([Fig. 3], [Video 1]).
Fig. 3
a, b Endoscopic papillary large balloon dilation was performed adjacent to the basket
using a balloon catheter (Giga II balloon, 10–12 mm; Century Medical Inc., Tokyo,
Japan). c During balloon deflation, the basket was gently withdrawn, and the impacted basket
and stones were successfully retrieved.
During pancreatic stone extraction, basket impaction occurred unexpectedly, which
was successfully resolved using endoscopic papillary large balloon dilation.Video
1
Although further studies to validate EPLBD’s safety and efficacy for similar cases
are warranted, this case demonstrates that in situations where the pancreatic duct
is sufficiently dilated, EPLBD can serve as an effective rescue technique when basket
impaction occurs during the pancreatic stone extraction.
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