Giant choledocholithiasis treated by mechanical lithotripsy using a gastric bezoar basket.
Mechanical lithotripsy (ML) is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no established endoscopic extraction method for such giant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct (CBD). Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An attempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capture the stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangiopancreatography; each of which took 30 min. No complications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.
Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea.
Hyun Jung
HJ
Chung
Seok
S
Jeong
Don Haeng
DH
Lee
Jung Il
JI
Lee
Jin-Woo
JW
Lee
Byoung Wook
BW
Bang
Kye Sook
KS
Kwon
Hyung Kil
HK
Kim
Yong Woon
YW
Shin
Young Soo
YS
Kim
D000368:Aged; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation*; D013523:Surgical Equipment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome