Year: 2026
Type: article
Study design: Case Report
Abstract: Methods for extracting pancreatic duct (PD) stones include pancreatic sphincterotomy, lithotripsy, and retrieval with balloons or baskets [ 1 ]. Basket impaction in the common bile duct is well recognized, impaction within the PD is uncommon [ 2 ] [ 3 ]. We present a case of an impacted basket during the attempted removal of a PD stone and describe a conservative approach that avoided surgical intervention. A 74-year-old woman with diabetes, hyperlipidemia, hypertension, and chronic kidney disease (stage 3) was evaluated for persistent abdominal pain. Computed topography (CT) revealed a large obstructing stones in the PD ([ Fig. 1 ]). She previously underwent two sessions of extracorporeal shockwave lithotripsy (ESWL) with 5,000 shocks each, resulting in only minimal symptom improvement. A tandem endoscopic retrograde cholangiopancreatography (ERCP) was performed with the second session of ESWL, and cannulation of the ventral PD revealed. A 6-mm pancreatic sphincterotomy and 4-mm balloon dilation were completed. During stone extraction, a flower basket became impacted within the PD and could not be withdrawn ([ Fig. 2 ]). Attempts with an emergency electrohydraulic lithotripsy (EHL) were unsuccessful. Fig. 1 Computed topography showed the pancreatic duct stone. Fig. 2 Fluoroscopy showing the stone and impacted basket. Pancreatoscopy was then used to directly visualize the stone. Additional EHL resulted in partial fragmentation, allowing the basket and stone to be grasped with jumbo forceps; however, both became lodged at the ampulla. Following the dilation of the PD orifice to 6 mm, the stone and basket were successfully removed. Two PD stents were placed, and no bleeding, leak, or perforation was noted ([ Video 1 ]). At a 6-week follow-up of ERCP, the pancreatogram confirmed complete stone clearance, prior stents were removed, and a new stent was placed. Four-week radiography confirmed spontaneous stent passage, and the patient reported significant improvement in pain. Download Video Pancreatoscopy with electrohydraulic lithotripsy (EHL).Video 1 Basket impaction within the PD is a challenging complication with limited management guidance. This case highlights a stepwise, minimally invasive strategy that achieved safe removal without surgery. Endoscopy_UCTN_Code_CPL_1AK_2AF Publication History Article published online: 02 April 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-2819-2846
Authors: Khalid Ahmed, Guru Trikudanathan
Institution: University of Minnesota
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7148468113