The “tapping-a-screw method” for endoscopic removal of an incarcerated pancreatic duct stone using a novel screw-shaped dilator with a 0.018-inch guidewire

Endoscopic intervention is an established treatment in patients with obstructive pancreatitis; however, dealing with impacted pancreatic duct stones remains challenging. Although electrohydraulic or laser lithotripsy under digital single-operator pancreatoscopy (D-SOP) is one of the feasible approaches [1], some special techniques are required in cases where D-SOP is not applicable [2] [3]. Herein, we report a method to accomplish endoscopic removal of an incarcerated pancreatic duct stone using a novel stiff screw-shaped dilator with a 0.018-inch guidewire.

A 70-year-old man with chronic pancreatitis underwent endoscopic pancreatic duct drainage for obstructive pancreatitis caused by an impacted pancreatic duct stone. However, the attempt failed because a tapered catheter could not pass through the stone. Therefore, we performed a method that we have called the “tapping-a-screw method” using a novel 7-Fr screw-shaped dilator (Tornus ES for 0.018 inch; Olympus Medical Systems, Tokyo, Japan) for endoscopic removal of the incarcerated pancreatic duct stone. A 0.018-inch guidewire (Fielder 18; Olympus Medical Systems) was advanced beyond the stone, and the Tornus ES was advanced over the guidewire to contact the stone. Next, by turning its grip clockwise, the Tornus ES was passed through the stone without difficulty. After withdrawing it counterclockwise, the dislodged stone was successfully extracted using a mechanical lithotriptor (LithoCrush V; Olympus Medical Systems) without any complications ([Fig. 1], [Fig. 2], [Video 1]).

Fig. 1 Fluoroscopic images of the procedure. a A screw-shaped dilator was advanced over a 0.018-inch guidewire to contact an incarcerated pancreatic duct stone (arrow). b After advancing the dilator clockwise, it was passed through the stone. c The dislodged stone (arrow) after using the dilator. d The dislodged stone being removed with a mechanical lithotriptor.

Fig. 2 Endoscopic image of a removed pancreatic stone.

Video 1 The “tapping-a-screw method” for endoscopic removal of an incarcerated pancreatic duct stone using a novel screw-shaped dilator with a 0.018-inch guidewire.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Brewer Gutierrez OI, Raijman I, Shah RJ. et al. Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones. Endosc Int Open 2019; 7: E896-E903
• 2 Kitagawa S, Ishikawa S, Okamura K. Downstream balloon dilation technique for endoscopic removal of an impacted pancreatic duct stone after pancreatoduodenectomy. Endoscopy 2022; 54: E506-E507
• 3 Kitagawa S, Ishikawa S, Monden S. A novel technique for the treatment of impacted pancreatic stones after pancreatoduodenectomy using transanastomotic fluoroscopic-guided electrohydraulic lithotripsy. Endoscopy 2022; 54: E617-E618

Publikationsverlauf

Artikel online veröffentlicht:
13. Dezember 2022