Endoscopic “cutting” of a trapped Dormia basket

Mechanical lithotripsy is effective for removal of large bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) but is a complex procedure with a risk of complications [1]. The availability of alternative techniques to extract difficult stones (i. e. endoscopic papillary large balloon dilation [EPLBD] and cholangioscopy-assisted lithotripsy) [2] has resulted in a decline in the use of mechanical lithotripsy. Nevertheless, cholangioscopy-assisted lithotripsy is an advanced technique, not widely available, and is still expensive.

Complications of mechanical lithotripsy can be challenging to manage. We describe a method of removing a trapped Dormia basket.

A 78-year-old woman with a history of recurrent cholangitis underwent ERCP for common bile duct stones. Two stones (10 × 15 mm and 15 × 20 mm) ([Fig. 1]) were seen on cholangiogram. After sphincterotomy and 15-mm EPLBD, the smaller stone was extracted using a Fogarty balloon. The larger stone could not be removed, and intra-endoscopic mechanical lithotripsy was attempted ([Fig. 2]); however, the Dormia wires broke near the handle of the lithotriptor despite being specially designed for mechanical lithotripsy.

Fig. 1 Cholangiogram showed two large bile duct stones.

Fig. 2 Attempted mechanical lithotripsy to remove the larger stone.

The Dormia basket was made of Nitinol with a “crimp” that joins the four wires ([Fig. 3 a]). The trapped basket was pulled closer to the papilla, making it possible to visualize the “crimp.” Argon plasma coagulation (APC2; ERBE, Tübingen, Germany; Forced setting, 80 W) was then used to trim the two wires between the “crimp” and the tip of the basket ([Fig. 3 b], [Video 1]); the trapped Dormia was finally retrieved using another small (10 mm) over-the-wire basket ([Fig. 4]). Plastic stents were inserted near the stone and the patient was referred for cholangioscopy-assisted lithotripsy, which was successful.

Fig. 3 The Nitinol Dormia basket. a The basket has a crimp (arrow) that joins the four wires of the basket. b The wires were cut (arrow) between the crimp (arrowhead) and the tip of the basket.

Video 1 Application of argon plasma coagulation to trim the wires of a trapped Nitinol Dormia basket for retrieval.

Fig. 4 Removal of the trapped Dormia with another small basket.

The use of APC to trim the meshes of self-expandable metal stents has been reported previously [3] and can be considered for “cutting” other endoscopic devices when necessary for their retrieval.

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Publication History

Article published online:
26 June 2020

• References

• 1 Thomas M, Howell DA, Carr-Locke D. et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol 2007; 102: 1896-1902
• 2 Manes G, Paspatis G, Aabakken L. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491
• 3 Demarquay JF, Dumas R, Peten EP. et al. Argon plasma endoscopic section of biliary metallic prostheses. Endoscopy 2001; 33: 289-290