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Calcified bile duct stone not crushable by endotriptor or mechanical lithotriptor: case report
Kenji Utsunomiya1, Kiichi Tamada, Takeshi Tomiyama
1Department of Gastroenterology, Jichi Medical School, Tochigi, Japan.
Summary
Basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. Even powerful endotriptors may fail to crush impacted bile duct stones, especially calcified ones.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Biliary tract interventions
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure for managing bile duct stones.
- Basket impaction is a known complication during stone extraction.
- Mechanical lithotripsy and endotriptors are standard tools for managing impacted stones.
Observation:
- A case of bile duct stone basket impaction occurred during ERCP.
- The impacted stone could not be crushed using a mechanical lithotriptor.
- An endotriptor, a more powerful device, also failed to fragment the impacted stone.
Findings:
- The impacted bile duct stone proved exceptionally hard and resistant to fragmentation.
- Calcified bile duct stones, even when apparent on abdominal radiography, may be too hard for standard lithotripsy devices.
- Failure of both mechanical lithotripsy and endotriptor necessitates consideration of alternative extraction methods.
Implications:
- Clinicians should exercise caution when encountering apparent calcified bile duct stones during ERCP.
- The hardness of calcified stones may exceed the capabilities of current lithotripsy technology.
- Further research into advanced lithotripsy techniques or alternative stone removal strategies is warranted for refractory cases.