Case Report
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World J Gastroenterol. Jul 7, 2012; 18(25): 3327-3330
Published online Jul 7, 2012. doi: 10.3748/wjg.v18.i25.3327
Giant choledocholithiasis treated by mechanical lithotripsy using a gastric bezoar basket
Hyun Jung Chung, Seok Jeong, Don Haeng Lee, Jung Il Lee, Jin-Woo Lee, Byoung Wook Bang, Kye Sook Kwon, Hyung Kil Kim, Yong Woon Shin, Young Soo Kim
Hyun Jung Chung, Seok Jeong, Don Haeng Lee, Jung Il Lee, Jin-Woo Lee, Byoung Wook Bang, Kye Sook Kwon, Hyung Kil Kim, Yong Woon Shin, Young Soo Kim, Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon 400-711, South Korea
Author contributions: Chung HJ contributed to the conception and design of the paper; Jeong S critically revised the article for important intellectual content and performed the final approval of the article; Lee DH drafted the article; Lee JI, Lee JW, Bang BW, Kwon KS, Kim HK, Shin YW and Kim YS contributed to the administrative, technical, and logistic support.
Supported by Grant from Inha University Research
Correspondence to: Seok Jeong, MD, Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, 7-206, 3-Ga, Sinheung-Dong, Jung-Gu, Incheon 400-711, South Korea. inos@inha.ac.kr
Telephone: +82-32-8902548 Fax: +82-32-8902549
Received: August 31, 2011
Revised: November 21, 2011
Accepted: November 28, 2011
Published online: July 7, 2012
Abstract

Mechanical lithotripsy (ML) is usually considered as a standard treatment option for large bile duct stones. However, it is impossible to retrieve oversized stones because the conventional lithotripsy basket may not be able to grasp the stone. However, there is no established endoscopic extraction method for such giant stone removal. We describe a case of successful extraction of a 4-cm large stone using a gastric bezoar basket. A 78-year-old woman had suffered from upper abdominal pain for 20 d. Contrast-enhanced computed tomogram revealed a 4-cm single stone in the distal common bile duct (CBD). Endoscopic stone retraction was decided upon and endoscopic papillary balloon dilation was performed using a large balloon. An attempt to capture the stone using a standard lithotripsy basket failed due to the large stone size. Subsequently, we used a gastric bezoar basket to successfully capture the stone. The stone was fragmented into small pieces and extracted. The stone was completely removed after two sessions of endoscopic retrograde cholangiopancreatography; each of which took 30 min. No complications occurred during or after the procedure. The patient was fully recovered and discharged on day 11 of hospitalization. ML using a gastric bezoar basket is a safe and effective retrieval method in select cases, and is considered as an alternative nonoperative option for the management of difficult CBD stones.

Keywords: Giant choledocholithiasis; Mechanical lithotripsy; Bezoar basket; Common bile duct stone; Endoscopic papillary balloon dilatation