EXALT™ Model D Single-Use Duodenoscope With SpyGlass™ DS Direct Visualization System for Retained Common Bile Duct Stent and Stone Impaction

Eric Frizzell, M.D. Eric Frizzell, M.D.
Pinehurst Medical Clinic
Pinehurst, N.C.
 

Patient History & Assessment

An 86-year-old woman with a history of extended spectrum beta-lactamases escherichia coli cholangitis due to a retained common bile duct (CBD) stent presented to attempt complete clearance of her CBD. The stent had been initially placed seven years ago. She had been seen both locally and at a tertiary center with three previous attempts to remove the stent as the stent is not intended to be used as a permanent implant. These were only partially successful as the stent was impacted in a CBD stone cast of the bile duct.
Figure 1
 

Procedure

An ERCP was performed using EXALT Model D due to previous history of MDR infection. The CBD was cannulated and contrast injected, showing multiple stones in the CBD.
  1. After dilation of the previous sphincterotomy with a CRE™ Wireguided Balloon Dilatation Catheter, multiple stones were removed with balloon sweeps.

  2. The CBD was then examined with the SpyGlass™ DS system, revealing a retained stent in the mid CBD.

  3. The stent was removed with the SpyGlass Retrieval Basket.

  4. Multiple stones were found above a common hepatic duct stricture. These were fractured with EHL and fragments were removed with the basket.

  5. Stricture was biopsied with the SpyBite™ Biopsy Forceps.
 

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Case Outcome/Discussion

  • The patient was discharged after the procedure and has done well. The biopsy of the stricture showed only inflammation.

  • The use of the EXALT Model D system in patients with a history of MDR infection eliminates the risk of contamination of scopesto ineffective reprocessing.

  • The use of the SpyGlass System allowed direct visualization of the stent. Using the SpyGlass™ Retrieval Basket to capture the stent under direct visualization was straightforward.

  • Removing stone fragments and the stent required removing the entire Spyglass and Model D system from the patient in order to clear the basket. 

  • Ampullary dilation allowed for direct cannulation of the CBD with SpyGlass System.
 
 
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