LAUSR

A 61-year-old man with symptoms of chills and high fever had undergone pancreatoduodenectomy in 2009 because of pancreatic serous cystadenoma. Magnetic resonance cholangiopancreatography suggested stones in the common and left hepatic duct (▶Fig. 1). The type of the gastrointestinal reconstruction was ascertained from surgical records, and we used a cap-assisted colonoscope (PCF-PQ260; Olympus Medical Systems, Tokyo, Japan) for endoscopic retrograde cholangiopancreatography (ERCP). The removal of the common hepatic duct stones followed the ERCP sequence: intubation to the afferent limb, biliary cannulation, balloon dilation of the distal bile duct, and balloon-assisted stone extraction. When the left intrahepatic duct stones could not be removed using to this method, we carried out wireguided cannulation using an improved single-lumen stone extraction basket, in which a hole was made with the tip of a needle (▶Fig. 2) to allow it to be advanced over the guidewire (▶Fig. 3) into the desired segmental duct (▶Fig. 4). The stones were engaged and dragged into the intestinal tract without removing the guidewire (▶Video 1). This proE-Videos