Novel use of a balloon dilatation catheter to enable mechanical lithotripsy of difficult common bile duct stones after initial failed attempt: A case report

Abstract

HighlightsNovel technique for increasing working space in the common bile duct.May enable endoscopists to re-attempt mechanical lithotripsy after initial failed attempt.If successful, will decrease number of procedures patient has to undergo.Should be used only by advanced endoscopists.

Endoscopic Biliary Large Balloon Dilation Lithotripsy for Giant and Impacted Stones Removal: A Western Series

“…No perforation was observed in patients dilated from 12 to 15 mm [16] and in our technique, we never dilate >15 mm. The presence of a stone could increase the risk of perforation, but this was not observed in our study as well as in the one by Park et al [9] and 2 other case reports [7, 8]. We presume that harder stones, especially some cholesterol stones originated in the gallbladder, pose an extra perforation risk due to the fact that in large balloon lithotripsy, the stone is pressed against the bile duct wall and the wall in contact with the balloon or the stone may rupture.…”

“…Park et al [9] were the first to report the use of large balloon lithotripsy in 7 patients with giant or impacted stones with full success and no complications. Loh et al [7] reported a single case of large balloon lithotripsy in order to produce working space for the deployment of the basket. It must be emphasized that cholangioscopy-guided laser or electro-hydraulic lithotripsy also has a stone clearance rate of approximately 70–90%, requires 1 to 2 sessions beyond the index ERCP, and is also not a complication-free procedure, especially with an increased cholangitis rate, although perforations or bleeding, due to the lithotripsy method, could very rarely occur [2, 4, 12, 14].…”

“…In such cases, stone fracture, usually by cholangioscopy-guided intracorporeal lithotripsy, is mandatory. Case reports from Eastern authors were the first to describe the inflation of a large balloon dilator completely inside the biliary tree in order to facilitate difficult bile duct stone removal [7-9]. In this study, we describe the results of an alternative stone disintegration technique in a considerable series of patients using an esophageal/pyloric balloon for stone fragmentation or making working space in the bile duct to allow the deployment of the basket, a technique we call endoscopic biliary large balloon lithotripsy.…”

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

“…ERCP failure to extract stones may be due to failed cannulation (i.e., Juxta-papillary diverticulum, intra-diverticular papilla or small papilla), or failed extraction [ [35] , [36] , [37] , [38] , [39] ]. The failed extraction occur with difficult stones (i.e Mirrizi's syndrome, stricture of the lower CBD, impacted, large (<15 mm), multiple (<3), or intrahepatic duct/cystic duct stones), especially when using standard methods (balloon or basket after ES or endoscopic papillary balloon dilatation (EPBD)) [ 39 , 40 ].…”