Clin Endosc.  2018 Nov;51(6):596-599. 10.5946/ce.2018.057.

Treatment Using the SpyGlass Digital System in a Patient with Hepatolithiasis after a Whipple Procedure

• Harima H
• Hamabe K
• Hisano F
• Matsuzaki
• Itoh T
• Sanuki K
• Sakaida I

• KMID: 2430405
• DOI: http://doi.org/10.5946/ce.2018.057

Abstract

An 89-year-old man was referred to our hospital for treatment of hepatolithiasis causing recurrent cholangitis. He had undergone a prior Whipple procedure. Computed tomography demonstrated left-sided hepatolithiasis. First, we conducted peroral direct cholangioscopy (PDCS) using an ultraslim endoscope. Although PDCS was successfully conducted, it was unsuccessful in removing all the stones. The stones located in the B2 segment were difficult to remove because the endoscope could not be inserted deeply into this segment due to the small size of the intrahepatic bile duct. Next, we substituted the endoscope with an upper gastrointestinal endoscope. After positioning the endoscope, the SpyGlass digital system (SPY-DS) was successfully inserted deep into the B2 segment. Upon visualizing the residual stones, we conducted SPY-DS-guided electrohydraulic lithotripsy. The stones were disintegrated and completely removed. In cases of PDCS failure, a treatment strategy using the SPY-DS can be considered for patients with hepatolithiasis after a Whipple procedure.

Keyword

Hepatolithiasis; Whipple procedure; Cholangioscopy; SpyGlass digital system

MeSH Terms

Aged, 80 and over
Bile Ducts, Intrahepatic
Cholangitis
Endoscopes
Endoscopes, Gastrointestinal
Humans
Lithotripsy

Figure

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  Fig. 1. Computed tomography results. (A) Axial view. (B) Coronal view. Computed tomography images showing a calcified stone impacted within the intrahepatic bile duct of the left lobe.

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  Fig. 2. Cholangiography results. (A) An ultraslim endoscope was inserted directly into the left hepatic duct. (B) Cholangiography image showing two large stones in the common trunk of the intrahepatic bile duct of segment 2 and segment 3 (arrows).

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  Fig. 3. Peroral direct cholangioscopy (PDCS) results. (A) PDCS image showing a large stone located in the common trunk of the intrahepatic bile duct of segment 2 and segment 3. (B) The volume of the stone was reduced using biopsy forceps during PDCS.

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