Newly Developed Endotriptor for Patients with Basket Impaction in the Distal Common Bile Duct

Abstract

We have developed a new endotriptor that can be used through the instrument channel of the duodenoscope. The coiled metal sheaths are 53 cm long and 2.4 mm in diameter (Figure 1 a), and fit over the remaining wire of the basket catheter. "Remaining wire" here means the length of wire between the entrance of the in− strument channel port on the duodeno− scope and the cut end of the wire. The sheaths are designed to be slightly shorter than the "remaining wire". This allows easy insertion of a sheath over the wire and into the endoscope. An Olympus JF− 200 duodenoscope and an FG 22−Q−1 or 403Q basket catheter (Olympus, Tokyo, Japan), the length and diameter of which are suitable for the new endotriptor, were used.When basket impaction occurs with a bile stone in the distal common bile duct, the basket catheter is cut at the handle. Only the tube sheath should then be pulled out, leaving the wire inside the endo− scope. Three coiled metal sheaths from the endotriptor are inserted over the bas− ket wire and into the duodenoscope. The end of the sheath is then gripped with a vise (Figure 1 b). The endotriptor can be pulled out with the basket catheter after the stone has been crushed. In 20 patients who had basket impaction after endo− scopic sphincterotomy and underwent lithotripsy with the new endotriptor, the stones were crushed successfully in all cases. There were no complications such as biliary perforation or bleeding.The endotriptors currently available can− not be used without withdrawing the duodenoscope from the patient [1]. The duodenoscope then has to be reinserted to extract the fragments of a stone imme− diately after traditional lithotripsy. With the new endotriptor, the required maneu− vers can be carried out without removing the duodenoscope ± a considerable ad− vantage. There is no chance of injuring the mucosa of the upper gastrointestinal tract with the new endotriptor, as it pas− ses through the endoscope. In addition, the distal common bile duct is never at risk of being perforated by the tip of the new endotriptor, as the impacted basket can be returned to the upper bile duct by pushing the endotriptor.

Nonsurgical Management of an Impacted Mechanical Lithotriptor with Fractured Traction Wires: Endoscopic Intracorporeal Electrohydraulic Shock Wave Lithotripsy Followed by Extra-Endoscopic Mechanical Lithotripsy

“…Following lithotripsy, the duodenoscope is reintroduced to clear the bile duct from fragmented stone particles. Recently, several newly developed through-the-scope lithotriptors have been introduced for the management of basket impaction in the CBD (20)(21)(22). Alternatively, a second through-the-scope mechanical Figure 5) Fluoroscopy revealing fragmented stone particles following intracorporeal electrohydraulic shock wave lithotripsy with a second basket to remove stone fragments Figure 6) Fluoroscopy showing final fragmentation of the stone within the impacted basket, which was completed with a Soehendra metal sheath (Cook Medical, USA) introduction over the wires lithotriptor can be used to crush the stone within the impacted mechanical lithoptripsy basket (23).…”

Successful Retrieval of an Impacted Mechanical Lithotripsy Basket: A Case Report

“…At endoscopic stone removal it is essential to have suitable accessories available, particularly the extra‐endoscopic mechanical lithotripter or the newly developed TTS lithotripters, 8,9 in the event that entrapment of a basket occurs. In our patient we first attempted to use the Soehendra TTS lithotripter, but the central wire of the basket fractured at the handle portion, which made further attempts with this type of device impossible.…”