A 54-year-old woman was treated following episodes of epigastric
pain due to a large stone in the main pancreatic duct and a long (approximately
3 cm) stricture at the head of the pancreas ([Fig. 1 a]).
Fig. 1 a Pancreatic duct
stricture. b Dilating the stricture with a biliary
balloon. c Plastic stents and the pancreatic stone.
d Stone captured with the basket and pushed back to the
dilated portion of the duct. e Dilating the stricture
with a controlled radial expansion balloon. f Endoscopic
image of stone extraction.
She underwent endoscopic retrograde cholangiopancreatography (ERCP),
where dilation of the pancreatic duct was performed using an 8-mm biliary
dilating balloon (Boston Scientific, Natick, Massachusetts, USA) ([Fig. 1 b]). Four single pig-tail pancreatic
stents (7 Fr × 8 cm) were placed ([Fig. 1 c]). During a second ERCP 3 months
later, the stents were retrieved and the pancreatic stricture was further
dilated with a 10-mm biliary dilating balloon (Cook Medical, Bloomington,
Indiana, USA). A new attempt to remove the stone using an extraction balloon
(Cook Medical) was unsuccessful. We then used a dormia basket; however, this
became impacted with the stone inside it. A 10-11-12 controlled radial
expansion (CRE) balloon (Boston Scientific) was then advanced parallel to the
basket wire, in order to push the stone to the dilated portion of the duct ([Fig. 1 d]), and then further dilation of the
stricture with the same balloon was performed. To our surprise, a new attempt
to retrieve the stone was again unsuccessful. We then tried to dilate the
pancreatic duct even further, with a 12-13.5-15 CRE balloon ([Fig. 1e]). Following this procedure, the basket and
the stone were finally removed ([Fig. 1 f]). To finish, a single pig-tail
pancreatic stent, 7 Fr × 8 cm, was placed to
prevent pancreatitis. The patient progressed well and was discharged 2 days
later.
According to our knowledge, this is the first reported use of a
balloon dilator larger than 10 mm in the pancreatic duct
[1]
[2]
[3]. To
date, CRE balloons, the only alternative to existing biliary balloon dilators,
which do not exceed this diameter, have only been used to dilate the biliary
sphincterotomy site and retrieve large bile duct stones [4]
[5].
Endoscopy_UCTN_Code_TTT_1AR_2AI
