Finding
We report here a novel technique of balloon−assisted insertion of an ultrathin scope into the common bile duct.
Paper
Balloon-assisted insertion of a cholangioscope into the common bile duct: a novel technique.
Abstract
ultrathin endoscope in direct cholangios− copy and endoscopic retrograde cholan− giopancreatography has been reported recently [1 ±4]. However, difficulties are occasionally encountered when inserting a scope into the common bile duct be− cause the scope is sometimes pushed too far downward in the duodenum (l" Fig. 1 a, b). We report here a novel technique of balloon−assisted insertion of an ultrathin scope into the common bile duct. Two large stones with diameters of around 3 cm were found in the dilated common bile duct of an 89−year−old man with epigastric pain and jaundice. Unfor− tunately, we failed to remove all the stones by mechanical lithotripsy using a standard side−viewing duodenoscope be− cause some of the fragmented stones were impacted deep in the common bile duct, and they could not be removed using a basket or extraction balloon cath− eter under fluoroscopic guidance. We also failed to reach the remaining stones with an ultrathin forward−viewing endo− scope (EG530N5; Fujinon−Toshiba, Tokyo, Japan) using a guide wire, as described by Larghi & Waxman [1]. We therefore placed a duodenal balloon (a 30−mL balloon catheter; Top Corp., Tokyo, Japan) as a fulcrum to make insertion of the en− doscope easier (l" Fig. 1 c, d and 2 a, b). This technique made deep insertion of the scope possible and we successfully removed all the stones using a basket catheter under direct cholangioscopy (l" Fig. 2 c, d). To our knowledge, this is the first report on duodenal balloon−assisted insertion of a cholangioscope. Another cholangio− scopic technique that uses a “babyscope” has been described but this is expensive and cumbersome, and is not suitable for lithotripsy because of the limited number of channels. Moreover, insertion of an en− doscope using a guide wire [1] does not always work, as in the present case. We overcame these difficulties by using a duodenal balloon as a crosstie, avoiding the need for a guide wire. Our method is easy to perform and so could be widely applied in direct cholangioscopy.
Authors
A. Mori, H. Tatebe, N. Ohashi
Journal
Endoscopy