Successful Endoscopic Removal of a Clip-stone Complex Following Laparoscopic Cholecystectomy: A Case Report

Abstract

An 84-year-old woman with a history of laparoscopic cholecystectomy for gallbladder stone disease 6 years earlier presented to our outpatient clinic. She was referred to gastroenterology for a thorough examination after blood tests showed liver dysfunction. An abdominal non-contrast computed tomography scan showed a hyperdensity area in the common bile duct with a suspected metallic component, and we diagnosed a clip-stone complex caused by a migrated clip. Laparoscopic cholecystectomy has become the standard of care for cholecystolithiasis, and as the number of operations increases, it is important to keep post-cholecystectomy clip migration in mind as a late postoperative complication. We decided to perform endoscopic retrograde cholangiography to remove the complex stones, and performed a balloon catheter stone removal procedure with endoscopic papillary large balloon dilation (EPLBD). There have been reports of emergency surgery due to stone interference between the clip and catheter when a basket catheter was used to remove stones. We argue that balloon catheter stone removal in combination with EPLBD should be considered for clip-stone complexes.