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CC BY 4.0 · Endoscopy 2025; 57(S 01): E1312-E1314
DOI: 10.1055/a-2729-2731
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Combined approaches to rescue an entrapped pancreatic stone basket

Authors

  • Fan Fan‡

    1   Department of Gastroenterology, Peking University People’s Hospital, Beijing, China (Ringgold ID: RIN71185)

  • Jin-Hui Yi‡

    2   School of Medicine, NanKai University, Tianjin, China (Ringgold ID: RIN481107)
    3   Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China (Ringgold ID: RIN651943)

  • Aiqiao Fang

    4   Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China (Ringgold ID: RIN12520)

  • Liang-Hao Hu

    5   Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China (Ringgold ID: RIN12520)
    4   Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China (Ringgold ID: RIN12520)
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A 56-year-old male patient with chronic pancreatitis presented to our hospital. Computed tomography identified multiple radiopaque calculi within the pancreatic duct ([Fig. 1]). The patient underwent three sessions of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction [1] [2].

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Fig. 1 Computed tomography identified multiple radiopaque calculi within the pancreatic duct.

ERCP revealed main pancreatic duct stenosis with multiple filling defects. Sphincterotomy and subsequent balloon dilation were performed, achieving ductal expansion to 1 cm in diameter. A spiral stone retrieval basket was employed to extract the stones. However, the basket became entrapped in the pancreatic duct due to an excessive amount of adherent stone debris ([Fig. 2]). The handle of the basket was cut ([Fig. 3] a), and the duodenoscope was withdrawn from the alimentary tract with a basket wire inserted into the working channel simultaneously, leaving the stone-laden basket within the pancreas and basket wire extending out of the patient’s mouth ([Fig. 3] b–d). An additional session of P-ESWL was subsequently performed.

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Fig. 2 The spiral stone retrieval basket was entrapped in the pancreatic duct.
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Fig. 3 a The handle of the spiral stone retrieval basket was cut. b The duodenoscope was withdrawn from the alimentary tract while the basket wire inserted into the working channel simultaneously. c The basket wire extended out of the patient’s mouth. d The stone-laden basket within the pancreas. The red arrows show the movement of the duodenoscope and the yellow arrows show the movement of the basket wire.

Forceps was then introduced through the working channel of the duodenoscope to grasp the end of the basket wire ([Fig. 4] a, b). The forceps, along with the wire, were then retracted through the working channel while the scope was re-advanced to the duodenal papilla ([Fig. 4] c and d). Attempts were made to extract the basket, but significant resistance was encountered. A balloon catheter was inserted to further dilate the papilla to a diameter of 1.1 cm ([Fig. 5] a). Despite this, basket retrieval remained challenging. A sphincterotome was then utilized to fragment the stone debris within the basket, reducing the overall volume of the stone–basket complex ([Fig. 5] b, c). Ultimately, the basket, along with the stones, was successfully extracted ([Fig. 5] d, [Video 1]).

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Fig. 4 a Forceps was introduced through the working channel of the duodenoscope. b Forceps grasped the end of the basket wire. c The forceps, along with the wire, were retracted through the working channel while duodenoscope re-advanced. d The basket wire was retracted through the working channel. The red arrows show the movement of the duodenoscope and the yellow arrows show the movement of the basket wire and forceps.
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Fig. 5 a A balloon catheter was inserted to further dilate the papilla. b Basket retrieval remained challenging. c A sphincterotome was utilized to fragment the stone debris within the basket. d The basket, along with the stones, were successfully extracted.
Sphincterotome-assisted fragmentation to rescue an entrapped pancreatic stone basket.Video 1

Basket entrapment is an undesirable complication during endoscopic pancreatic stone removal. Various rescue techniques, including P-ESWL, sphincterotomy, and laser lithotripsy, have been reported in the literature to cope with such situations [3] [4] [5]. In this case, we successfully managed this complicated scenario through a combination of approaches, including P-ESWL, balloon dilation and an innovative sphincterotome-assisted fragmentation technique.

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Publication History

Article published online:
19 November 2025

© 2025. 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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