LAUSR

A 68-year-old man with a history of Roux-en-Y partial gastrectomy for gastric cancer and pancreatic enucleation for a somatostatin-producing neuroendocrine tumor underwent urgent open cholecystectomy due to acute cholecystitis. Intraoperative choledochoscopy showed a common bile duct (CBD) stone which could not be removed. A transcystic Nelaton tube was placed. One week later, cholangiography confirmed the 10-mm CBD stone was still present. The tube was left in place to allow maturation of the tract for a further procedure, but 20 days later it was accidentally displaced. As percutaneous biliary drainage persisted, the patient was referred to us to try percutaneous transcystic cholangioscopy-guided electrohydraulic lithotripsy. Contrast instilled directly into the percutaneous access confirmed persistence of the tract, which was tortuous and narrowed in the proximal part (▶Fig. 1). Guidewire passage into the CBD was difficult (▶Fig. 2) and was only achieved under contrast guidance with looping of the guidewire and single-operator cholangioscope (Spyglass DS II) assistance. Passage of the cholangioscope into the CBD was possible after gentle dilatation of the proximal part of the tract, and the stone was visualized in the distal part of the CBD (▶Fig. 3). Electrohydraulic lithotripsy was performed under direct visualization with pulverization of the stone (▶Fig. 4; ▶Video 1). A 10-Fr double-pigtail plastic stent was left in place for 24h E-Videos