Electrohydraulic lithotripsy for the treatment of stone impacted in a lumen-apposing metal stent in a patient with endoscopic cholecystoduodenostomy

Abstract

Electrohydraulic lithotripsy for the treatment of stone impacted in a lumen-apposing metal stent in a patient with endoscopic cholecystoduodenostomy An 89-year-old woman presented to our department having experienced acute cholecystitis a few weeks previously. Her comorbidities, chronic kidney disease, and congestive heart failure meant she was not a suitable candidate for surgery. She underwent EUS-guided gallbladder drainage, which was performed without complications. During this procedure, a 10-mm × 10-mm lumen-apposing metal stent (LAMS) (Hot Axios; Boston Scientific) was implanted for gallbladder drainage. A few days later, the patient complained of right-upper quadrant abdominal pain and fever, and a new acute cholecystitis episode was diagnosed.

Recanalization of a completely occluded biliary metal stent using argon plasma coagulation and electrohydraulic lithotripsy

“…The recanalization of the stent was accomplished in 10 minutes without bleeding or any unpleasant result (Figure 1C, Video S1), and additionally, the stones above the occluded stent were removed using mechanical lithotripsy (Figure 1D). Biliary metal stent trimming using APC has been reported to be a safe and useful therapeutic approach, 1,2 and reintervention for a stent‐stone complex using EHL has been reported to be a treatment option 3,4 . Distally migrated and/or completely occluded stents are retrieved and replaced as long as they are removable, and “stent‐in‐stent technique” might be a feasible option for removing unobstructed self‐expandable metal stents 5 .…”

“…Biliary metal stent trimming using APC has been reported to be a safe and useful therapeutic approach, 1,2 and reintervention for a stent-stone complex using EHL has been reported to be a treatment option. 3,4 Distally migrated and/or completely occluded stents are retrieved and replaced as long as they are removable, and "stent-in-stent technique" might be a feasible option for removing unobstructed self-expandable metal stents. 5 Although in our case the distally migrated, completely occluded stent was unremovable, we managed to overcome the complicated situation by using APC and EHL.…”