Troubleshooting impaction of a pancreatoscopy-guided retrieval basket during pancreatic duct stone removal

eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIyZDNkMjZlN2Y4MmIwYTEzNDM4OTRiYTRjM2Y0Y2UwMCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg4MTUzODU4fQ.FRrWy8muPU4-HKxjfB-nvaAAbqQHUkK-Zkr9bQXk_-VLyGYaFmhgaPo3U3TzcSH4NV2NSg7BHiTZ7_vSYnmkErK4vn7geGZNnyQseEvuswCdLgEPvUGoJzsRaeN4anZkgcmB2Eqdj5TU16j3TQVlF3LtCZ1f0tInJ_WeC6cZFcVy6s7eFGoLHHWiT0xuYsFPQg_LUPtVhtIZppILE8JNBBD4k7GsdYAoBXcFnES8fVEZamwe2i7IYAzMsLTQ1giMXeqy8i-rXV5Qf90_1cR8lPLGs1Nkgl3KWBSGdb41aB07QMeEG92IJrg-DWbGFQDfFd3bnTw4TCOUWPdw8SZHdw(mp4, (93.11 MB) Download video Successful removal of impacted cholangiopancreatoscopy-guided retrieval basket. Pancreatic duct (PD) stones are a common adverse event chronic pancreatitis that can cause pain via ductal obstruction. Symptomatic patients eligible for endoscopic or surgical treatment, with first-line treatment strategies including ERCP stone extraction and/or extracorporeal shockwave lithotripsy.1Dumonceau J.-M. Delhaye M. Tringali A. et al.Endoscopic pancreatitis: European Society Gastrointestinal Endoscopy (ESGE) Guideline—updated August 2018.Endoscopy. 2019; 51: 179-193Crossref PubMed Scopus (171) Google Scholar Peroral pancreatoscopy-guided lithotripsy, laser lithotripsy electrohydraulic (EHL), enables under direct visualization, high rate technical and clinical success (88.1% 87.1%, respectively) while maintaining low (12.1%).2Brewer Gutierrez O.I. Raijman I. Shah R.J. al.Safety efficacy digital single-operator pancreatoscopy obstructing pancreatic stones.Endosc Int Open. 7: E896-E903Crossref Scholar,3Han S. Brauer B.C. al.A comparison retrograde pancreatography without stones.Pancreas. 48: 690-697Crossref (9) However, limited data exist regarding the use cholangiopancreatoscopy-specific basket PD stones. In this video, we report case 68-year-old man who presented an acute exacerbation established pancreatitis, recent EUS showed multiple (Video 1, available online at www.videogie.org). An was performed initial pancreatogram demonstrating dilated (9 mm) large intraductal Following sphincterotomy balloon dilation, found in head pancreas, blocking advancement any device past 1). The decision therefore made to perform pancreatoscopy. Using pancreatoscope (SpyScope DS II, Boston Scientific, Marlborough, Mass, USA), successfully identified several EHL (Autolith Touch, Northgate Technologies Inc, Elgin, Ill, USA) medium-high power (3 probes, ∼15,000 shocks over 45 minutes) fragmentation most genu pancreas. One (Fig. 1) refractory remained, however, attempt remove it (SpyBasket, Scientific), but once captured stone, became within 2). Upon forceful attempts basket, wires broke off catheter still holding firmly stone. Several unsuccessful were using biopsy forceps, grasping device, sweeping balloon. Pancreatoscopy repeated as salvage maneuver on through 3, Video (1 probe, medium power, 2000 10 allowed complete 4) remaining debris swept procedure ended placement 7F plastic stent, patient discharged home uneventfully.Figure 2Impacted stone.View Large Image Figure ViewerDownload Hi-res image (PPT)Figure 3Electrohydraulic basket.View 4Cholangiopancreatoscopy-guided upon after impaction.View (PPT) is inserted cholangiopancreatoscope allow capture visualization. With 15-mm diameter, contains parachute design accommodates up mm diameter. This be particularly useful extracting larger conventional fluoroscopic guidance.4Han Cholangioscopy-guided stones.VideoGIE. 2020; 5: 387-388Abstract Full Text PDF (5) Unexpected impaction potential require intervention, has been reported viable rescue option these cases.5Terauchi T. Shinozaki Inoue Lefor A.K. H. Nonsurgical basket-stone by cutting metallic lithotripter lithotripsy.VideoGIE. 2021; 6: 416-418Abstract (0) Scholar,6Zhu Cocks F.H. Preminger G.M. Zhong P. role stress waves cavitation comminution shock wave lithotripsy.Ultrasound Med Biol. 2002; 28: 661-671Abstract (178) cases baskets lacking literature. Interestingly, also demonstrates how EHL, which initially unsuccessful, achieved successful enveloped Although may simply byproduct accumulation greater number shocks, alternatively suggest entrapment metal fibers allows reflected tensile reverberate passes stone.6Zhu summary, illustrates usefulness impaction, nonsurgical intervention. Dr consultant advisory board he Cook Medical. other authors did not disclose financial relationships. Han supported Path K award from Ohio State University College Medicine Office Research Center Clinical Translational Science Richard & Marie R. Bremer Medical Fund William Davis Endowment Basic Research. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIyZDNkMjZlN2Y4MmIwYTEzNDM4OTRiYTRjM2Y0Y2UwMCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjg4MTUzODU4fQ.FRrWy8muPU4-HKxjfB-nvaAAbqQHUkK-Zkr9bQXk_-VLyGYaFmhgaPo3U3TzcSH4NV2NSg7BHiTZ7_vSYnmkErK4vn7geGZNnyQseEvuswCdLgEPvUGoJzsRaeN4anZkgcmB2Eqdj5TU16j3TQVlF3LtCZ1f0tInJ_WeC6cZFcVy6s7eFGoLHHWiT0xuYsFPQg_LUPtVhtIZppILE8JNBBD4k7GsdYAoBXcFnES8fVEZamwe2i7IYAzMsLTQ1giMXeqy8i-rXV5Qf90_1cR8lPLGs1Nkgl3KWBSGdb41aB07QMeEG92IJrg-DWbGFQDfFd3bnTw4TCOUWPdw8SZHdw .mp4 Help files 1Successful