LAUSR

We present the case of a 77-year-old man with an enterolith and severe jejunal stricture causing afferent loop syndrome, who was successfully treated with endoscopic balloon dilation and subsequent electrohydraulic lithotripsy (EHL). The patient underwent Whipple’s operation and radiotherapy for duodenal cancer in 2004 and regularly visited the outpatient clinic without evidence of recurrence. In August 2019, he visited the emergency room with epigastric clamping pain, nausea, vomiting, and fever. Laboratory findings showed a cholestatic pattern of elevated liver function test and hyperbilirubinemia. Computed tomography revealed a short segmental jejunal narrowing with an impacted ovalshaped stone (1.6 cm) causing upstream afferent loop dilation (▶Fig. 1) [1, 2]. The stricture site was reached by antegrade colonoscope (PCF H290D; Olympus, Tokyo, Japan) (▶Fig. 2). Contrast media was injected into the afferent loop and revealed segmental narrowing and a huge filling defect (▶Fig. 3). The stricture site was dilated with a controlled radial expansion balloon (Boston Scientific, Galway, Ireland; 8mm, 10atm, 30 seconds) (▶Fig. 4,▶Video 1). A large yellowish enterolith was noted on the proximal side of the jejunal stricture. We fragmented the stone using an EHL probe (3 Fr 3m; WA09408A, Walz Elektronik GmbH, Rohrdorf, Germany) and electrohydraulic shock wave generator (Lithotron EL-27 Compact; Walz Elektronik GmbH) (▶Fig. 5) [3, 4]. EHL of the enterolith was performed with saline irrigation through the working channel of the scope (▶Video 1). The enterolith fragments were then retrieved using a basket (▶Fig. 6). Forceps biopsy of the stricture site was obtained and revealed chronic enteritis. The patient’s symptoms resolved, and laboratory findings returned to normal after treatment. E-Videos