Basket Extraction for Challenging Intrahepatic Ductal Stones

Douglas G. Adler, M.D. Gregory Haber, MD
Chief of Endoscopy
Director of Advanced Therapeutics and Innovation
Division of Gastroenterology

Bassem Matta, MD
Advanced Therapeutic Endoscopy Fellow

Gurneet Bedi, MD Gastroenterology and Hepatology Fellow
Division of Endoscopy
NYU Langone Hospital
New York, NY
 

Patient History & Assessment

A 47-year-old female with a history of recurrent pyogenic cholangitis and choledochoduodenostomy (Figure 1, 2), was referred for recurrent cholangitis episodes ascribed to intrahepatic ductal stones which could not be extracted through conventional methods.

Figure 1

Haber procedure image 1

Figure 2

Haber procedure image 2


Procedure

Cholangiogram through choledochoduodenostomy revealed multiple filling defects located mostly in liver segment IV. Extraction of many stones was achieved using a SpyGlass™ Retrieval Basket through 18 Fr gastroscope. Segment IV takeoff was dilated to 8 mm using a through the scope balloon. Cholangioscopy using SpyScope™ DS through therapeutic gastroscope with cap was performed revealing many remaining intraductal stones (Figure 3). Extraction of stones with SpyGlass Retrieval Basket enabled complete clearance of segment IV stones (Figure 4, 5).

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Figure 3
Haber procedure image 3
Figure 4
Haber procedure image 4
Figure 5
Haber procedure image 5
 
 
 

Outcome & Conclusion

The patient was discharged the same day on oral antibiotics and has done well since. This case highlights the advantages of using a SpyGlass Retrieval Basket to extract otherwise difficult stones. The small diameter of the SpyGlass Retrieval Basket sheath allows for use of this device through smaller channel endoscopes and cholangioscope. The use of this device did not affect visualization in most of the case and allowed for effective and targeted stone extraction through direct capturing of specific stones.

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