{"title":"Laser lithotripsy with balloon enteroscopy-assisted peroral cholangioscopy for a large common bile duct stone after Billroth II gastrectomy","authors":"Haruo Miwa, Kazuya Sugimori, Shin Maeda","doi":"10.1111/den.14888","DOIUrl":null,"url":null,"abstract":"<p>Endoscopic procedures for large common bile duct stones in patients with altered anatomy remain challenging, despite reports on direct peroral cholangioscopy (POCS).<span><sup>1-4</sup></span> Recently, a novel slim cholangioscope (9F eyeMAX; Micro-Tech, Nanjing, China) facilitated balloon enteroscopy-assisted POCS (BE-POCS).<span><sup>5</sup></span></p><p>An 83-year-old man, after Billroth II gastrectomy, was admitted with a large common bile duct stone. BE-POCS using a Holmium YAG (Ho:YAG) laser was employed for stone removal (Video S1). A balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was inserted into the afferent loop, and cholangiography revealed a large stone (15 mm) in the dilated common bile duct (20 mm). After papillary balloon dilation (15 mm), 9F eyeMAX was smoothly inserted via enteroscopy. A large stone was located in the hepatic hilum. Ho:YAG laser (LithoEVO; EDAP TMS, Lyon, France) lithotripsy effectively crushed the stone core under cholangioscope guidance (Fig. 1). The irrigation ability was sufficient to maintain a clear view because of a separate irrigation channel. A basket catheter (LithoCrush V; Olympus) was used to remove the fragments; however, the largest piece could not be extracted, and mechanical lithotripsy failed. A plastic stent was placed until the second session because of the procedure length (100 min). One month later, the largest fragment was completely crushed using the Ho: YAG laser to prevent basket impaction (Fig. 2). The green color of the laser helped detect the probe tip during the procedure. The fragmented stones were removed using a spiral basket catheter (KANEKA Medics, Tokyo, Japan). Cholangioscopy confirmed no residual stones in the intrahepatic bile ducts. Finally, small fragments were extracted using a microbasket catheter (ABIS, Hyogo, Japan) (60 min).</p><p>This is the first report of laser lithotripsy with BE-POCS for a patient with Billroth II gastrectomy. Ho:YAG laser lithotripsy using a slim cholangioscope is useful for treating difficult stones in patients with altered anatomy.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1059-1061"},"PeriodicalIF":5.0000,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14888","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14888","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Endoscopic procedures for large common bile duct stones in patients with altered anatomy remain challenging, despite reports on direct peroral cholangioscopy (POCS).1-4 Recently, a novel slim cholangioscope (9F eyeMAX; Micro-Tech, Nanjing, China) facilitated balloon enteroscopy-assisted POCS (BE-POCS).5
An 83-year-old man, after Billroth II gastrectomy, was admitted with a large common bile duct stone. BE-POCS using a Holmium YAG (Ho:YAG) laser was employed for stone removal (Video S1). A balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was inserted into the afferent loop, and cholangiography revealed a large stone (15 mm) in the dilated common bile duct (20 mm). After papillary balloon dilation (15 mm), 9F eyeMAX was smoothly inserted via enteroscopy. A large stone was located in the hepatic hilum. Ho:YAG laser (LithoEVO; EDAP TMS, Lyon, France) lithotripsy effectively crushed the stone core under cholangioscope guidance (Fig. 1). The irrigation ability was sufficient to maintain a clear view because of a separate irrigation channel. A basket catheter (LithoCrush V; Olympus) was used to remove the fragments; however, the largest piece could not be extracted, and mechanical lithotripsy failed. A plastic stent was placed until the second session because of the procedure length (100 min). One month later, the largest fragment was completely crushed using the Ho: YAG laser to prevent basket impaction (Fig. 2). The green color of the laser helped detect the probe tip during the procedure. The fragmented stones were removed using a spiral basket catheter (KANEKA Medics, Tokyo, Japan). Cholangioscopy confirmed no residual stones in the intrahepatic bile ducts. Finally, small fragments were extracted using a microbasket catheter (ABIS, Hyogo, Japan) (60 min).
This is the first report of laser lithotripsy with BE-POCS for a patient with Billroth II gastrectomy. Ho:YAG laser lithotripsy using a slim cholangioscope is useful for treating difficult stones in patients with altered anatomy.
Authors declare no conflict of interest for this article.
期刊介绍：
Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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