Digestive Endoscopy | 2019
Efficient clearance of intractable biliary calculi by combination of mechanical clamping and electrohydraulic lithotripsy
Abstract
CHOLANGIOSCOPY‐GUIDED ELECTROHYDRAULIC LITHOTRIPSY (EHL) is a feasible treatment for biliary calculi. However, some intractable calculi are unable to be fragmented despite long-term exposure to repeated EHL with high voltage. Furthermore, the diffused energy may cause persistent damage to the wall of the bile duct, which results in serious complications. Herein, we introduce a new clamping-assisted EHL (CEHL) method to achieve efficient fragmentation of intractable calculi (Video S1). In a patient with hepatolithiasis (Fig. 1) who underwent cholangioscopic therapy (CHF-V; Olympus, Tokyo, Japan), one intractable calculus impacted in the basket (JHY-BAS18-70-15-N4-B-O; Jiuhong, Changzhou, China) could not be fragmented by repeated EHL (70–90 V, DLZ-1; Yidalong, Beijing, China; Fig. 2a), which caused red mucosa as a result of hyperemia. To prevent potential hemorrhage, and to withdraw the impacted basket, CEHL was applied. First, biopsy forceps (MTN-BF-18/12-A, Micro-Tech, Nanjing, China) were inserted to preliminarily break the hard surface of calculus (Fig. 2b). By mechanical clamping, a depression on the surface was generated to focalize the energy of lithotripsy. As the EHL probe was reintroduced targeting the weak area created by clamping (Fig. 2c), repeated lithotripsy was carried out to favorably fragment the impacted calculus (Fig. 2d). Finally, the impacted basket