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DOI: 10.1055/a-2281-9683
Endoscopic lithotripsy for an impacted biliary stone at the confluence of the cystic duct and common bile duct using a novel drill dilator
Endoscopic retrograde cholangiopancreatography (ERCP) is widely performed for patients with common bile duct (CBD) stones. Many cases are successfully managed with endoscopic sphincterotomy and stone removal using balloon or basket catheters. However, for difficult or complex stones, ERCP with conventional techniques may fail to achieve biliary clearance in 10–15% of cases [1]. Peroral cholangioscopy-guided electrohydraulic lithotripsy (POCS-EHL) is effective in these cases; however, it is expensive and time-consuming. Herein, we report a case of endoscopic lithotripsy for an impacted stone at the confluence of the cystic duct (CD) and CBD using a novel drill dilator.
A 77-year-old woman with a high fever and abdominal pain was admitted to our institution. Blood tests showed obstructive jaundice, and computed tomography revealed a common bile duct stone ([Fig. 1]). ERCP revealed the stone was present at the confluence of the CD and CBD ([Fig. 2] a). Although stone removal using a mechanical lithotriptor (LithoCrush V; Olympus Medical Systems, Tokyo, Japan) was attempted, it was difficult to catch and crush the stone because of the narrow working space ([Fig. 2] b). Although POCS-EHL is an alternative procedure, it is not regularly performed in our institution. Therefore, endoscopic lithotripsy was performed using a novel drill dilator (Tornus ES; ASAHI INTECC, Aichi, Japan and Olympus Medical Systems, Tokyo, Japan) for the confluence stone. With a clockwise rotation, the drill dilator could be passed through, while chipping away at the stone, without requiring a strong pushing force. The stone was completely removed using conventional basket and balloon catheters during a single ERCP session ([Fig. 3], [Video 1]). It is thought that the twisting force of the drill dilator was easily transmitted to the impacted stone, which has poor mobility, leading to lithotripsy.
Endoscopic lithotripsy using a novel drill dilator is useful in patients with an impacted biliary stone at the confluence of the CD and CBD.
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Publication History
Article published online:
03 April 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Reference
- 1 Kedia P, Tarnasky PR. Endoscopic management of complex biliary stone disease. Gastrointest Endosc Clin N Am 2019; 29: 257-275