Endoscopic stone extraction using a balloon enteroscope in patients with a Roux-en-Y anastomosis is challenging due to the difficulty in aligning the axis between retrieval devices and stones, which often results in failure of stone capture [1 ]
[2 ]. Recently, it has been reported that a novel thin cholangioscope (EyeMax; Micro-Tech, China), with a length of 219 cm and a diameter of 9 Fr, enables peroral cholangioscopy (POCS)-guided procedures using a balloon enteroscope with a 3.2-mm forceps channel ([Fig. 1 ]) [3 ]
[4 ]. Furthermore, it also enables POCS-guided basket extraction. We report a case of successful POCS-guided basket extraction of intrahepatic bile duct stones using a novel thin cholangioscope under balloon enteroscopy in a patient who had undergone a Roux-en-Y procedure.
Fig. 1 Thin cholangioscope (EyeMax; Micro-Tech, China), length 219 cm, diameter 9 Fr.
A 68-year-old woman who had undergone hepaticojejunostomy with Roux-en-Y construction was
referred to us. Computed tomography revealed stones in the intrahepatic bile duct ([Fig. 2 ]). Although the previous hospital had attempted stone extraction, the stones could not be
captured using the basket catheter. Therefore, we performed endoscopic retrograde
cholangiopancreatography (ERCP) using a short-type single-balloon enteroscope (SIF-H290;
Olympus, Japan) with a working length of 152 cm and a working channel of diameter 3.2 mm [1 ] ([Video 1 ]). Cholangiography revealed stones in the intrahepatic bile duct ([Fig. 3 ]). Subsequently, POCS was performed using a thin cholangioscope, revealing stones in the
intrahepatic bile duct ([Fig. 4 ]). Since the stones were considered difficult to capture, POCS-guided basket extraction
was attempted using a retrieval basket (SpyGlass Retrieval Basket; Boston Scientific, USA)
([Fig. 5 ]
a ), that could be inserted through the thin cholangioscope. The
stones were successfully captured under cholangioscopic visualization ([Fig. 5 ]
b, c ). Finally, complete stone extraction was confirmed using
the cholangioscope ([Fig. 5 ]
d ).
Fig. 2 Computed tomography revealed stones (arrows) in the intrahepatic bile duct.
Fig. 3 Cholangiography revealed stones (arrows) in the intrahepatic bile duct.
Fig. 4 Cholangioscopic view of stones in the intrahepatic bile duct.
Fig. 5 Cholangioscopic and endoscopic findings. a Retrieval basket
(SpyGlass Retrieval Basket; Boston Scientific, USA) that could be inserted through the thin
cholangioscope. b, c The stones were successfully captured under
cholangioscopic visualization. d Complete stone extraction was
confirmed using the cholangioscope.
Peroral cholangioscopy-guided basket extraction of intrahepatic bile duct stones, using a novel thin cholangioscope under balloon enteroscopy, in a patient with Roux-en-Y anatomy.Video 1
POCS-guided basket extraction is beneficial for capturing difficult stones, as POCS allows for direct visualization of stones [5 ]. This thin cholangioscope enables POCS-guided basket extraction under balloon enteroscopy in patients with Roux-en-Y anatomy.
Endoscopy_UCTN_Code_TTT_1AR_2AH
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