Elsevier

Gastrointestinal Endoscopy

Volume 64, Issue 6, December 2006, Pages 1031-1033
Gastrointestinal Endoscopy

Brief Report
Biliary-basket impaction complicated by in vivo traction-wire fracture: report of a novel management approach

https://doi.org/10.1016/j.gie.2006.04.023Get rights and content

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Case report

A 76-year-old man with choledocholithiasis was referred for ERC. The CBD was easily accessed, and cholangiography demonstrated 3 filling defects in a 7-mm CBD (Fig. 1). After maximal biliary sphincterotomy, initial attempts to clear the stones with a balloon catheter failed. Thus, a 7F Web Extraction Basket (Cook Endoscopy) was passed into the distal CBD and at least 1 stone was captured. Unfortunately, the stone(s) would not fragment, and the basket could not be withdrawn into the duodenum (

Discussion

Very few cases describe the convergence of 2 potential complications of endoscopic stone extraction: a lithotripsy basket impacted in the CBD and its traction wires severed in vivo. Reported management strategies have included the following: use of extracorporeal shock wave lithotripsy ± laser lithotripsy to fragment the stone to facilitate basket retrieval with a forceps or a snare3, 4; use of a second endoscopic mechanical lithotripsy basket to capture the first basket and to crush the stone5

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Cited by (15)

  • Technique for Retrieving Basket and Lithotripter During Endoscopic Retrograde Cholangiopancreatography

    2015, Clinical Gastroenterology and Hepatology
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    Our case was unique because it not only reports a concurrence of 2 rare complications (ie, impaction of both the retrieval basket and a mechanical lithotripter) but also the failure of previously described salvage methods. Management options for such situations include surgical exploration of the bile duct vs a conservative management strategy with antibiotics and repeat attempts by ERCP.2 In a conservative strategy, it is important to ensure good biliary drainage by placement of a temporary stent along with administration of antibiotics for the prevention of cholangitis and sepsis.3

  • Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

    2014, Techniques in Gastrointestinal Endoscopy
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    In the most refractory cases, patients may be managed with placement of a bridging stent or nasobiliary catheter after coiling the basket wires in the stomach. Occasionally the basket may spontaneously migrate into the duodenum [50]. Migration of plastic stents placed in the pancreaticobiliary system has been observed in 5%-6% of patients [51-54] and migration of biliary and pancreatic stents can occur both internally (ie, travel deeper into the duct) and distally (ie, travel out of the duct) [54,55].

  • Large-balloon dilation of the biliary orifice for the management of basket impaction: A case series of 6 patients

    2011, Gastrointestinal Endoscopy
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    Although the incidence of a basket impaction with an entrapped stone was reported in 5.9% patients7,13; because of the developments in the therapeutic techniques for CBD stones, this incidence has been decreased to 0.8%,14 comparable to the rate observed in our case series (0.65%). Despite its low incidence, impaction of a basket with an entrapped stone in the distal CBD may cause cholestatic jaundice accompanied by acute suppurative cholangitis, acute pancreatitis, sepsis,15 and even death, particularly in patients with comorbid diseases, thereby usually requiring open surgery or specialized endoscopic interventions.7-12 However, some of those “rescue” procedures are not widely available in many parts of the world, and most require considerable expertise to achieve a successful outcome.

  • Biliary and pancreatic stone extraction devices

    2009, Gastrointestinal Endoscopy
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    A stone extraction basket that cannot be removed from the biliary or pancreatic ducts while still attached to its catheter represents a medical emergency, and rescue lithotripsy using specialized accessories designed for this occurrence may be required to allow removal of the basket. A variety of endoscopic, radiologic, and surgical techniques have been used to remedy this situation.25-31 Some modern stone extraction baskets contain built-in safety features to minimize the risk of basket entrapment/impaction.

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