Intrahepatic bile duct stone removal through endoscopic ultrasound-guided hepaticogastrostomy using novel basket catheter under digital cholangioscopy guidance

Although the digital single-operator cholangioscope (SpyGlass DS, Boston Scientific, Marlborough, Massachusetts, USA) has clinical impact in various procedures, such as forceps biopsy or endoscopic hydraulic lithotripsy [1] [2] [3] [4], the small diameter of the working channel is one of the limitations of this scope. Recently, a novel basket catheter (Micro-Catch; MTW Endoskopie, Düsseldorf, Germany) has become available. This basket catheter, which has a sheath diameter of only 1 mm, can be inserted into the SpyGlass DS ([Fig. 1]). Herein, we describe intrahepatic bile duct stone removal using this basket catheter via SpyGlass DS through an endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) route.

Fig. 1 Novel basket catheter (Micro-Catch; MTW Endoskopie, Düsseldorf, Germany). The sheath diameter is only 1 mm, allowing insertion into the cholangioscope.

A 72-year-old man was admitted to our hospital because of obstructive jaundice caused by hepaticojejunostomy anastomotic stricture (HJAS). On computed tomography, intrahepatic bile duct dilatation and the HJAS were observed ([Fig. 2]). An EUS-guided approach was therefore attempted.

Fig. 2 On computed tomography imaging, a dilated intrahepatic bile duct and stricture at the hepaticojejunostomy anastomosis were observed.

First, the intrahepatic bile duct was punctured using a 19-gauge fine-needle aspiration needle and contrast medium was injected. After cholangiography, the endoscopic retrograde cholangiopancreatography (ERCP) catheter and a 0.025-inch guidewire (VisiGlide; Olympus Medical Systems, Tokyo, Japan) were inserted. Next, contrast medium was injected again, and the intrahepatic bile duct stone was seen above the HJAS ([Fig. 3]). EUS-HGS was performed using a covered metal stent (10 mm × 10 cm, Niti-S Biliary S-Type Stent Long Suture; TaeWoong Medical, Seoul, Korea).

Fig. 3 The intrahepatic bile duct stone was seen in the hepaticojejunostomy anastomosis during endoscopic ultrasound-guided hepaticogastrostomy.

After 1 week, the metal stent was removed, and the SpyGlass DS catheter was inserted into the biliary tract through the EUS-HGS route. Next, the intrahepatic bile duct stone was grasped using a novel basket catheter though the SpyGlass DS ([Fig. 4], [Video 1]), and the stone was removed into the stomach ([Fig. 5]). Finally, EUS-HGS using a plastic stent (Type IT; Gadelius Medical Co., Ltd., Tokyo, Japan) was performed without any adverse events.

Fig. 4 The intrahepatic bile duct stone was grasped using a novel basket catheter under cholangioscopic guidance.

Video 1 The cholangioscope was inserted into the biliary tract through a endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) route. The intrahepatic bile duct stone was observed and grasped by a novel basket catheter under cholangioscopic guidance. Finally, stone removal was successfully performed into the stomach through the EUS-HGS. 

Fig. 5 The intrahepatic bile duct stone was successfully removed.

This basket may be useful for the removal of intrahepatic bile duct stones using SpyGlass DS under ERCP and EUS-HGS guidance.

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• References

• 1 Ogura T, Kurisu Y, Onda S. et al. Prospective evaluation of digital single-operator cholangioscope for diagnosis and therapeutic procedures (with videos). Dig Endosc 2017; 29: 782-789
• 2 Ogawa T, Ito K, Koshita S. et al. Usefulness of cholangioscopic-guided mapping biopsy using SpyGlass DS for preoperative evaluation of extrahepatic cholangiocarcinoma: a pilot study. Endosc Int Open 2018; 6: E199-E204
• 3 Tanaka R, Itoi T, Honjo M. et al. New digital cholangiopancreatoscopy for diagnosis and therapy of pancreaticobiliary disease (with videos). J Hepatobiliary Pancreat Sci 2016; 23: 220-226
• 4 Navaneethan U, Hasan MK, Kommaraju K. et al. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience. Gastrointest Endosc 2016; 84: 649-655