Rescuing impacted biliary extraction basket using cholangioscopy-directed lithotripsy and a pulley system.

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Interventional Endoscopy

Background:

• Biliary extraction basket impaction during ERCP is a rare but serious adverse event.
• Failed mechanical lithotripsy can lead to basket entrapment.
• Management of impacted baskets poses a significant clinical challenge.

Purpose of the Study:

• To describe a novel endoscopic rescue technique for managing an impacted biliary extraction basket.
• To evaluate the efficacy of cholangioscopy-guided lithotripsy and an improvised pulley system.

Main Methods:

• A case of impacted biliary extraction basket following ERCP and mechanical lithotripsy is presented.
• Cholangioscopy-directed electrohydraulic lithotripsy was used to fracture the entrapped stone.
• An improvised pulley mechanism with grasping forceps was employed for basket extraction.

Main Results:

• The novel technique successfully fractured the entrapped stone and enabled extraction of the impacted basket.
• The patient recovered quickly and was discharged within 48 hours.
• No surgical intervention was required.

Conclusions:

• Cholangioscopy-guided lithotripsy is an effective method for releasing impacted biliary baskets.
• An improvised pulley technique offers a safe and minimally invasive solution for basket extraction.
• This approach provides a valuable alternative to surgery for impacted biliary baskets.