Intraductal cholangioscopy-guided electrohydraulic lithotripsy as a rescue therapy for impacted common bile duct stones within a Dormia basket.

The treatment of bile duct stones has evolved from surgery to endoscopic management, which has a success rate of 90% [1]. Impaction of the lithotripsy basket during endoscopic removal of a common bile duct (CBD) stones is seen in up to 5.9% of the cases [2,3] and represents one of the most feared complications; as it usually results in open surgical intervention. We report our experience with a 72-yearold woman who underwent laparoscopic cholecystectomy followed by an intraoperative cholangiogram, which demonstrated retained CBD stones. Subsequently, endoscopic retrograde cholangiopancreatography (ERCP) was performed and showed dilated proximal CBD measuring 12mm in diameter (●" Fig.1a) with multiple filling defects representing CBD stones of 10–20mm in diameter (●" Fig.1b). Multiple attempts were made to extract these stones, including the use of mechanical lithotripsy via a Dormia basket (Trapezoid RX; Boston Scientific, Marlborough, Massachusetts, USA), but these attempts were unsuccessful and resulted in impaction of the stones within the basket, such that it was not possible to close, open, or retrieve it. Fig.2 Cholangioscopic views showing: amultiple stones (red arrow) impacted within the Dormia basket (white arrows indicate the basket’s wires); b stone fragmentation under direct visualization using the electrohydraulic lithotripsy (EHL) probe (green arrow); cmultiple stone fragments (red arrows) after EHL was performed.