Short communication“Post-cut”: An endoscopic technique for managing impacted biliary stone within an entrapped extraction basket
Introduction
Ampullary impaction of an entrapped biliary extraction basket with a stone occurs not infrequently during endoscopic retrograde cholangiopancreatography (ERCP), with an estimated incidence between 0.8% and 5.9% [1], [2], [3], [4]. The existing endoscopic techniques and options include emergency mechanical lithotripsy after cutting the basket cable using a Soehendra mechanical lithotriptor, extracorporeal shock-wave lithotripsy (ESWL), endoscopic laser lithotripsy, large-balloon dilation of the biliary orifice, and surgery [4], [5], [6], [7], [8], [9]. However, these options usually significantly prolong the procedural time and costs, subject the patients to additional endoscopy even operation. In this study, the authors describe and report a “post-cut” technique for the retrieval of impacted stones and entrapped baskets. In contrast to “pre-cut”, which is performed to gain biliary access [10], the authors coined the term “post-cut” after an adequate biliary sphincterotomy has been performed, before attempted stone removal or subsequent endoscopic interventions. The aim of the study is to evaluate the feasibility, safety and efficacy of post-cut in for the treatment of 10 cases of impacted biliary stones within an entrapped extraction basket.
Section snippets
Patients
From October 2004 to August 2014, 3540 ERCPs were performed in 2655 patients with choledocholithiasis at the West China Hospital, Chengdu, China. The included study patients met the following criteria: ERCP was performed with a therapeutic duodenoscope (TJF240, Olympus, Tokyo, Japan) and a stone entrapped basket with a stone impacted in the ampulla treated with “post-cut”. Retrospective analysis was conducted in 10 included patients (7 men, 3 women; median age 64 years; range 35–80) (Table 1,
Results
From October 2004 to August 2014, the authors performed ERCP in 2655 patients with choledocholithiasis at West China Hospital, and 21 patients developed stone-basket impaction during ERCP. In 10 patients (7 men, 3 women; median age 64 years; range 35–80) with stone-basket impaction, (Table 1, Table 2; Fig. 1) ERCP was performed using a therapeutic duodenoscope with a large working channel (4.2 mm in diameter). Post-cut was carried out in all 10 patients. Of these patients who received post-cut,
Discussion
Endoscopic biliary sphincterotomy coupled with balloon dilatation of the ampulla and distal common duct is standard for stone extraction in choledocholithiasis [11]. Common ERCP-related complications include post-ERCP pancreatitis, post-sphincterotomy bleeding, perforation, and cholangitis [12]. Although ampullary impaction of entrapped stone-basket happens infrequently, it often leads to significantly prolonged procedural time, additional interventions, costs, and even operation. Managing
Funding
None.
Ethical approval
The work was approved by the appropriate ethical committees related to the institution in which it was performed and that subjects gave informed consent to the work.
Competing interests
No conflict of interest.
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Cited by (5)
Endoscopic Management of Complex Biliary Stone Disease
2019, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :This situation can be unnerving for the endoscopist, because failure to remove an impacted basket may require surgical intervention. Various techniques to remove impacted baskets have been described, including using a large external mechanical lithotriptor, laser or electrohydraulic lithotripter, second salvage basket, sphincterotomy extension, and grasping forceps.28–31 Because of the limitations of ES and ML, endoscopic papillary balloon dilation (EPBD) was proposed as an alternative technique for biliary stone extraction in 1982.32
Tres reportes de caso de canastilla de extracción de cálculo biliar impactada: Three case reports of impacted biliary stone extraction basket
2020, Revista de Gastroenterologia de MexicoERCP Stone Extraction: Complex
2023, Practical GastroenterologyLarge biliary stone: Lessons from a difficult case
2018, Digestive Endoscopy