Endoscopy 2020; 52(12): E459-E460
DOI: 10.1055/a-1167-0904
E-Videos

Broken handle cord of impacted biliary basket – rescue by cholangioscopy with laser lithotripsy

Tomislav Bokun
1   Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
,
Mario Tadic
1   Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
4   Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
,
Admir Kurtcehajic
2   Gastroenterology Unit, Department of Internal Medicine, Plava Poliklinika Medical Center, Tuzla, Bosnia and Herzegovina
3   Medical Faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina
,
Ivica Grgurevic
1   Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
,
Milan Kujundzic
1   Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
› Author Affiliations
 

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for the treatment of bile duct stones, and most stones are successfully removed with accessories such as biliary baskets or extraction balloons. Impaction of a biliary basket is not an uncommon complication of this procedure, being reported in 0.8 % – 5.9 % of cases. Mechanical lithotripsy usually solves the problem by crushing the stone, followed by extraction of the stone fragments. However, on rare occasions, fracture of the basket occurs during mechanical lithotripsy, and this can pose a special management problem, depending on where the breakage occurs [1] [2] [3]. We report the successful management of an impacted biliary basket after breakage of the basket handle cord during extra-endoscopic mechanical lithotripsy.

A 35-year-old man, who had undergone early laparoscopic cholecystectomy in a small regional hospital 1 month before, presented with jaundice and upper right quadrant pain on admission. Laboratory tests revealed obstructive jaundice with raised γ-glutamyl transpeptidase (γGT) and alkaline phosphatase (ALP) and a total bilirubin concentration of 11.11 mg/dL. Apart from a mildly dilated common bile duct (CBD) with stones, computed tomography of the abdomen revealed no abnormalities. ERCP was undertaken as part of the treatment plan.

After successful cannulation and sphincterotomy, two small stones were captured with a 20-mm basket but could not be extracted due to the discrepancy between the size of the stones and the small diameter of the distal CBD; in addition, it proved impossible to retrieve the stones from the basket. For this reason, extra-endoscopic mechanical lithotripsy using a Soehendra lithotriptor was undertaken, but the handle cord broke 15 cm from the basket and the basket–stone complex remained impacted, with the cord end flapping freely in the lumen of the duodenum ([Fig. 1]).

Zoom Image
Fig. 1 Cholangiogram showing the impacted biliary basket with the two entrapped stones while the rest of the wire trails free in the duodenum.

The next day the patient underwent ERCP with cholangioscopy and laser lithotripsy, and the stones were crushed within the impacted biliary basket; this was followed by successful extraction of the basket together with the fragments ([Video 1]). The final occlusion cholangiogram showed the CBD to be cleared ([Fig. 2]).

Video 1 Cholangioscopy followed by laser lithotripsy of the entrapped stone–basket complex. Once the stones had been successfully crushed, the basket was withdrawn using the forceps accessory.


Quality:
Zoom Image
Fig. 2 a Negative occlusion cholangiogram. b Normal cholangiogram after retrieval of the duodenoscope.

Endoscopy_UCTN_Code_CPL_1AK_2AC

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Correction

Correction: Broken handle cord of impacted biliary basket – rescue by cholangioscopy with laser lithotripsy
Bokun T, Tadic M, Kurtcehajic A et al. Broken handle cord of impacted biliary basket – rescue by cholangioscopy with laser lithotripsy. Endoscopy 2020, 52: E459–E460.
In the above-mentioned article, the institution affiliation for Mario Tadic has been corrected. Correct is that Mario Tadic belongs to these affiliations:
1 Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia
4 Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia

This was corrected in the online version on July 18, 2024.


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Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Attila T, May GR, Kortan P. Nonsurgical management of an impacted mechanical lithotriptor with fractured traction wires: endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy. Can J Gastroenterol 2008; 22: 699-702
  • 2 Khawaja FI, Ahmad MM. Basketing a basket: A novel emergency rescue technique. World J Gastrointest Endosc 2012; 4: 429-431
  • 3 Borgaonkar M. Impacted biliary basket. Gastrointest Endosc 2005; 62: 474

Corresponding author

Admir Kurtcehajic, MD
Plava Poliklinika Medical Center
3rd Tuzlanska Brigada No. 7
75000 Tuzla
Bosnia and Herzegovina   
Fax: +387-35-393111   

Publication History

Article published online:
19 May 2020

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  • References

  • 1 Attila T, May GR, Kortan P. Nonsurgical management of an impacted mechanical lithotriptor with fractured traction wires: endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy. Can J Gastroenterol 2008; 22: 699-702
  • 2 Khawaja FI, Ahmad MM. Basketing a basket: A novel emergency rescue technique. World J Gastrointest Endosc 2012; 4: 429-431
  • 3 Borgaonkar M. Impacted biliary basket. Gastrointest Endosc 2005; 62: 474

Zoom Image
Fig. 1 Cholangiogram showing the impacted biliary basket with the two entrapped stones while the rest of the wire trails free in the duodenum.
Zoom Image
Fig. 2 a Negative occlusion cholangiogram. b Normal cholangiogram after retrieval of the duodenoscope.