Integrated cholangioscopy-assisted lithotripsy and a novel basket approach for managing complex cystic duct confluence stones

Endoscopic retrograde cholangiopancreatography (ERCP)-guided extraction is the gold standard for biliary stone management. However, cystic duct confluence (CDC) stones pose significant challenges due to their unique anatomical and stone characteristics, with a lack of consensus on the optimal therapeutic approach [1] [2]. The issue is further compounded in cystic-dilated CDC spaces, in which stones are prone to escaping the retrieval catheter. Cholangioscopy-assisted lithotripsy is a promising technique that facilitates complex stone management through direct visual stone fragmentation [3]. Featuring a helical 8-wire design with a narrower interwire space at its tip and rotational capability, the novel basket (RASEN2; KANEKA Medix, Tokyo, Japan) has shown superior stone clearance versus conventional baskets in an experimental ex vivo setting [4]. We describe an integrated approach using cholangioscopy-assisted lithotripsy and RASEN2 for CDC stone removal.