The extraction of difficult bile duct stones in a patient with surgically altered anatomy using a novel retrieval basket and a short‐type single‐balloon enteroscopy

Extraction of common and intrahepatic bile duct stones is generally performed endoscopically. However, stone extraction in patients with surgically altered anatomy (SAA) is sometimes difficult.1, 2 One reason is that limited devices are available for balloon enteroscopy owing to the length and size of the working channel. A novel retrieval basket with a unique helical shape (VolticCatch V; Olympus Medical Systems, Tokyo, Japan; Figure 1) has been reported to be useful for extracting bile duct stones in a patient with SAA using a colonoscope with a working channel diameter of 3.7 mm.3 The previous model of VolticCatch V using a 0.018-inch guidewire could not pass through a working channel, 3.2 mm in diameter and 152 cm in length, of a short-type single-balloon enteroscope (SIF-H290S; Olympus Medical Systems) in difficult cases, such as making loops, but the improved model could pass through it (Figure 2). We report two cases of successful bile duct stone extraction in patients with SAA using this basket with a 0.018-inch guidewire and may be the first choice for SAA patients to remove small bile duct stones due to its unique shape. A 79-year-old male was referred for stone extraction. The patient underwent total gastrectomy with Roux-en-Y reconstruction for gastric cancer. Endoscopic retrograde cholangiopancreatography (ERCP) was performed using SIF-H290S. Cholangiography revealed multiple defects. We used a mechanical lithotripter and balloon catheter; however, the stones slipped through the basket and balloon near the papilla. Therefore, a novel basket was used after changing the guidewire from 0.025- to 0.018-inch. Finally, the stones could be removed. In another case, a 25-year-old female underwent choledochojejunostomy for congenital biliary dilatation. ERCP was performed for stone extraction using SIF-H290S. Cholangiography revealed a defect in the right hepatic duct. We could easily remove intrahepatic bile duct stones using a novel basket with a 0.018-inch guidewire. The authors confirm there is no conflict of interest. Video S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.