Impacted and Fractured Biliary Basket: A Second Basket Rescue Technique

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Interventions

Background:

• Management of large and multiple common bile duct stones often requires endoscopic retrograde cholangiopancreatography (ERCP).
• Basket extraction is a common method for stone removal, but impaction can occur, complicating the procedure.

Purpose of the Study:

• To describe a novel "rescue" technique for managing a fractured retrieval basket during ERCP for impacted common bile duct stones.
• To report a case of successful non-surgical removal of impacted stones using this innovative approach.

Main Methods:

• The patient underwent ERCP for large, multiple common bile duct stones.
• During a second ERCP, a retrieval basket became impacted with a stone.
• The basket handle was severed, and a lithotriptor sheath was advanced over the basket.
• Mechanical lithotripsy failed, and basket wires fractured.
• A "rescue" standard basket was used to engage and extract the entire fractured basket/stone complex.

Main Results:

• The "rescue" basket technique successfully disengaged and removed the impacted, fractured basket and stone complex.
• The procedure avoided the need for surgical intervention.
• This represents the third reported case of such a complication and its resolution in the English literature.

Conclusions:

• A "rescue" basket technique can be effective in managing fractured retrieval baskets during ERCP for impacted common bile duct stones.
• This method offers a non-surgical alternative for a rare but challenging complication.
• Further investigation into similar techniques may be warranted for difficult stone extraction cases.