The Extractor™ Pro RX and RX-S are retrieval balloon catheters used endoscopically for the removal of biliary or pancreatic stones and to facilitate the injection of a contrast medium while occluding the duct.

The squared shoulder design and the ability to inflate to two distinct sizes without the need to exchange devices allows you to extract stones efficiently.

The Extractor™ Pro RX-S also features an enhanced design with increased catheter stiffness, providing improved pushability and kink resistance. 

ESGE recommends performing a limited sphincterotomy combined with endoscopic papillary large-balloon dilation as the first-line approach to remove difficult common bile duct stones.³

The CRE™ RX Biliary Balloon Dilatation Catheter is indicated for use in adults for the endoscopic dilatation of the sphincter of Oddi with or without prior sphincterotomy and is available in lengths of 3cm and 5.5cm, with diameters ranging from 6–20mm. Each balloon can be inflated to three distinct and progressively larger diameters, providing flexibility in selecting the most anatomically appropriate approach for difficult stone extraction.

The Trapezoid™ RX Wireguided Retrieval Basket is used to crush and remove biliary stones.

Wire baskets are a well-established method of stone extraction; however, entrapment is a concern associated with this approach.^3,4

The Trapezoid™ RX basket has a disengaging tip which reduces the risk of impaction, ensuring the basket can be removed if the stone does not break.

In addition, the Flexi-Stiff™ catheter construction supports the Trapezoid™ RX with a flexible and robust design, built to bend with biliary anatomy while providing maneuverability. The metal alloy basket also maintains its symmetry, even after manipulating difficult stones.  

 

Managing difficult bile duct stones with balloon or basket catheters can be challenging. This may be due to their location (e.g., stones that are intra-hepatic or in the cystic duct), specific stone features, the anatomical characteristics of the biliary tract, or the patient’s clinical needs.¹ Cholangioscopy-assisted lithotripsy with electrohydraulic lithotripsy (EHL) or laser system are effective ESGE-recommended therapeutic options for the management of difficult bile duct stones.^*1

Results from a recent 2021 meta-analysis evaluating the efficacy and safety of cholangioscopy-assisted lithotripsy contribute to the body of evidence supporting this approach, which showed an overall stone fragmentation success of 95 %, a single session fragmentation and duct clearance of 82% and a rate of 4.6% for the adverse events.²

The ESGE recommends endoscopic biliary stent insertion in patients with irretrievable biliary stones that warrant biliary drainage.³ The Advanix™ Biliary Stent is a plastic stent that can be placed when large CBD stones cannot be removed to facilitate bile drainage and provide a short-term solution for alternative stone management approaches.¹²

Together with the NaviFlex™ RX Delivery System, the Advanix™ Biliary Stent is designed to improve patient outcomes by: 

• Maximizing flow rate
• Improving stent deliverability
• Enhancing procedural control and efficiency through pre-loaded stent and delivery system options
  

In most cases, early laparoscopic cholecystectomy is considered the treatment of choice for acute cholecystitis. However, in patients who are elderly, critically ill, or with significant comorbidities, cholecystectomy is considered a high-risk procedure and gallbladder drainage (GBD) is recommended as an alternative treatment.^13,14

Of note, the ESGE recommends that in patients at high surgical risk, EUS-guided GBD should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions with EUS-GBD.¹⁴

NOTE: Ensure there is sufficient space within the target structure to accommodate the Hot AXIOS^TM stent flange diameter.
Gallbladder – Select a stent lumen diameter 10 mm or 15 mm based on gallbladder content via EUS imaging.
WARNING: The safety and effectiveness of the 20 mm stent for drainage of the gallbladder and bile duct has not been established.
The stent length (8 mm or 10 mm) is selected to accommodate the combined tissue wall thickness.
Refer to device Instructions for Use for additional Contraindications, Warnings and Precautions.