Extracorporeal shock wave lithotripsy allows successful endoscopic removal of a fractured stone basket trapped in the pancreatic duct.

A51-year-oldmanwith chronicpancreatitis presented with recurrent postprandial epigastric pain. Computed tomography (CT) of the abdomen revealed a9-mmpancreaticolith in the main pancreatic duct (MPD) of the head portion. Endoscopic retrograde cholangiopancreatography (ERCP)wasperformed to remove the pancreaticolith. After the pancreatic duct had been cannulated, sphincterotomy was performed. We attempted to remove the pancreaticolith with a lithotripsy basket (GML-06-26-430; MediGlobeGmbH,Germany); however, thebasket became trapped by the pancreaticolith in theMPD.Mechanical lithotripsy (StoneBuster; Medi-Globe GmbH, Germany) was tried (●" Fig.1a), but the wire of the basket fractured and the pancreaticolith became tangled up in the fractured basket (●" Fig.1b). Attempted removal of the fractured basket and pancreaticolith complex failed because they were tightly impacted in the narrow portion of the MPD. To minimize the risk of pancreatitis due to obstruction of the MPD, a 5-Fr plastic stent was inserted through the minor duodenal papilla. Extracorporeal shock wave lithotripsy (ESWL) to the impacted pancreaticolith was started on the day after the ERCP using a third-generation lithotriptor (PiezoLith 3000 plus; ELvation Medical GmbH, Germany) [1]. The repeated ESWL could be focused accurately on the pancreaticolith because it was held tightly together with the fractured basket in the pancreatic duct. After the 11th ESWL treatment (3000 shocks per session at an intensity of 16 on a scale of 1–20), a further ERCP was attempted. A guidewire was successfully passed through the impacted basket and stone. After a 6-mm balloon (Hurricane Rx hydrostatic balloon; Boston Scientific, Natick Massachusetts, USA) had been dilated in the narrow portion of the MPD, the fractured basket was removed with a forceps (FB-19N-1; Olympus, Tokyo, Japan) (●" Figs. 2–4). Following this, the fragmented pancreaticolith was also successfully removedby sweepingwith thebasket and balloon (●" Fig.5).