'Post-cut': An endoscopic technique for managing impacted biliary stone within an entrapped extraction basket

Background and study aims Ampullary impaction of an entrapped stone-basket complex is not an infrequent yet challenging event during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study is to evaluate the feasibility, safety, and efficacy of “post-cut” for the management of such scenarios. Patients and methods Patients with impacted biliary stone with an entrapped basket during ERCP at West China Hospital, Chengdu, China, from October 2004 to August 2014 were included in this retrospective study. Adequate biliary sphincterotomy was performed in all cases before attempted stone basket removal. Using free hand needle knife techniques, the authors extended the sphincterotomy along the long axis of the distal common bile duct to manage the biliary stone-basket impaction. In comparison with “pre-cut”, the authors coined the term “post-cut” referring to this technique. The feasibility, safety, and potential complications of post-cut were analysed. Results “Post-cut” was performed in consecutive 10 cases of impacted biliary stone within an entrapped extraction basket. The size of the removed stone ranged from 6 mm to 13 mm. The length of post-cut is 2 mm to 4 mm. The impacted basket was easily retrieved in all patients without complications, including bleeding, perforation, and pancreatitis . Conclusion “Post-cut” is a feasible, effective, and safe endoscopic technique when impaction of a biliary stone with an entrapped extraction basket develops.