Although the digital single-operator cholangioscope (SpyGlass DS, Boston Scientific,
Marlborough, Massachusetts, USA) has clinical impact in various procedures, such as
forceps biopsy or endoscopic hydraulic lithotripsy [1 ]
[2 ]
[3 ]
[4 ], the small diameter of the working channel is one of the limitations of this scope.
Recently, a novel basket catheter (Micro-Catch; MTW Endoskopie, Düsseldorf, Germany)
has become available. This basket catheter, which has a sheath diameter of only 1 mm,
can be inserted into the SpyGlass DS ([Fig. 1 ]). Herein, we describe intrahepatic bile duct stone removal using this basket catheter
via SpyGlass DS through an endoscopic ultrasound (EUS)-guided hepaticogastrostomy
(HGS) route.
Fig. 1 Novel basket catheter (Micro-Catch; MTW Endoskopie, Düsseldorf, Germany). The sheath
diameter is only 1 mm, allowing insertion into the cholangioscope.
A 72-year-old man was admitted to our hospital because of obstructive jaundice caused
by hepaticojejunostomy anastomotic stricture (HJAS). On computed tomography, intrahepatic
bile duct dilatation and the HJAS were observed ([Fig. 2 ]). An EUS-guided approach was therefore attempted.
Fig. 2 On computed tomography imaging, a dilated intrahepatic bile duct and stricture at
the hepaticojejunostomy anastomosis were observed.
First, the intrahepatic bile duct was punctured using a 19-gauge fine-needle aspiration
needle and contrast medium was injected. After cholangiography, the endoscopic retrograde
cholangiopancreatography (ERCP) catheter and a 0.025-inch guidewire (VisiGlide; Olympus
Medical Systems, Tokyo, Japan) were inserted. Next, contrast medium was injected again,
and the intrahepatic bile duct stone was seen above the HJAS ([Fig. 3 ]). EUS-HGS was performed using a covered metal stent (10 mm × 10 cm, Niti-S Biliary
S-Type Stent Long Suture; TaeWoong Medical, Seoul, Korea).
Fig. 3 The intrahepatic bile duct stone was seen in the hepaticojejunostomy anastomosis
during endoscopic ultrasound-guided hepaticogastrostomy.
After 1 week, the metal stent was removed, and the SpyGlass DS catheter was inserted
into the biliary tract through the EUS-HGS route. Next, the intrahepatic bile duct
stone was grasped using a novel basket catheter though the SpyGlass DS ([Fig. 4 ], [Video 1 ]), and the stone was removed into the stomach ([Fig. 5 ]). Finally, EUS-HGS using a plastic stent (Type IT; Gadelius Medical Co., Ltd., Tokyo,
Japan) was performed without any adverse events.
Fig. 4 The intrahepatic bile duct stone was grasped using a novel basket catheter under
cholangioscopic guidance.
Video 1 The cholangioscope was inserted into the biliary tract through a endoscopic ultrasound
(EUS)-guided hepaticogastrostomy (HGS) route. The intrahepatic bile duct stone was
observed and grasped by a novel basket catheter under cholangioscopic guidance. Finally,
stone removal was successfully performed into the stomach through the EUS-HGS.
Fig. 5 The intrahepatic bile duct stone was successfully removed.
This basket may be useful for the removal of intrahepatic bile duct stones using SpyGlass
DS under ERCP and EUS-HGS guidance.
Endoscopy_UCTN_Code_TTT_1AR_2AH
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos