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DOI: 10.1055/s-0043-103404
Successful removal of an impacted stone in the common bile duct by electric lithotripsy using a needle-knife and a forward-viewing endoscope
Corresponding author
Publikationsverlauf
Publikationsdatum:
22. März 2017 (online)
Although stones in the common bile duct (CBD) can be endoscopically removed [1] [2], stone impaction in the CBD occasionally occurs as a severe complication [3] [4]. We encountered a case of stone impaction in the CBD after endoscopic papillary balloon dilation (EPBD), which could be successfully treated by electrically cutting the stone using a needle-knife.
A 68-year-old man visited our hospital because of acute cholangitis. Abdominal computed tomography revealed a calcified stone of 10 mm in diameter in the CBD ([Fig. 1]). After obtaining informed consent, we attempted endoscopic retrograde cholangiopancreatography (ERCP) using a duodenoscope (JF260V; Olympus, Tokyo, Japan), and diagnosed choledocholithiasis ([Fig. 1]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl1.jpg)
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We performed EPBD (QBD-8X3; Cook Medical, Inc., Bloomington, Indiana, USA) ([Fig. 2]). Although we attempted stone extraction using a basket catheter (Nitinol-lithotomy basket, 4 wires, 25 × 40 mm; MTW Endoskopie, Wesel, Germany), the stone was tightly impacted within the biliary orifice ([Fig. 3]). After cutting and removing the outer sheath of the impacted catheter, we exchanged the instrument to a forward-viewing endoscope (GIF-Q260; Olympus) with a hood (Elastic Touch, slit&hole, F-010; Top Corp., Tokyo, Japan) attached to its tip. After positioning the endoscope close to the impacted stone, we electrically cut the stone using a needle-knife (KD-1L-1; Olympus) (Forced Coagulation 50 W, ICC200; Erbe, Tübingen, Germany) under direct visualization, in a fashion similar to the technique of endoscopic submucosal dissection [5] until stone reduction was confirmed ([Fig. 4]; [Video 1]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl2.jpg)
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![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl4.jpg)
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Qualität:
After breaking the stone with grasping forceps (FG-47L-1; Olympus) ([Fig. 4]; [Video 1]), we could easily extract the impacted stone by pulling the impacted wire through the duodenoscope, which had been inserted to the second part of the duodenum using the wire for guidance ([Fig. 5]). No adverse events occurred during or after the procedure.
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl5.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
This technique has been suggested to be useful for the retrieval of impacted stones associated with ERCP. However, its reported use is limited to case reports; therefore, further evaluation should be performed in the future.
Endoscopy_UCTN_Code_TTT_1AR_2AH
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Competing interests
None
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References
- 1 Classen M, Ossenberg FW. Non-surgical removal of common bile duct stones. Gut 1977; 18: 760-769
- 2 Shah SK, Mutignani M, Costamagna G. Therapeutic biliary endoscopy. Endoscopy 2002; 34: 43-53
- 3 van Dullemen H, Stuifbergen WNHM, Juttmann JR. et al. Simple release of an impacted Dormia basket during endoscopic bile duct stone extraction. Endoscopy 1993; 25: 374
- 4 Ryozawa S, Iwano H, Taba K. et al. Successful retrieval of an impacted mechanical lithotripsy basket: a case report. Digest Endosc 2010; 22: S111-S113
- 5 Gotoda T, Ho KY, Soetikno R. et al. Gastric ESD current status and future directions of devices and training. Gastrointest Endoscopy Clin N Am 2014; 24: 213-233
Corresponding author
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References
- 1 Classen M, Ossenberg FW. Non-surgical removal of common bile duct stones. Gut 1977; 18: 760-769
- 2 Shah SK, Mutignani M, Costamagna G. Therapeutic biliary endoscopy. Endoscopy 2002; 34: 43-53
- 3 van Dullemen H, Stuifbergen WNHM, Juttmann JR. et al. Simple release of an impacted Dormia basket during endoscopic bile duct stone extraction. Endoscopy 1993; 25: 374
- 4 Ryozawa S, Iwano H, Taba K. et al. Successful retrieval of an impacted mechanical lithotripsy basket: a case report. Digest Endosc 2010; 22: S111-S113
- 5 Gotoda T, Ho KY, Soetikno R. et al. Gastric ESD current status and future directions of devices and training. Gastrointest Endoscopy Clin N Am 2014; 24: 213-233
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0043-103404-i0062cl5.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)