Volume 3, Issue 3, Pages (March 2018)

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Volume 3, Issue 3, Pages 91-93 (March 2018) Endoscopic treatment of large impacted pancreatic ductal stone using digital pancreatoscopy and electrohydraulic lithotripsy Hitoshi Shibuya, MD, Hisatomo Ikehara, MD, PhD, Emmanuel Coronel, MD, Takuji Gotoda, MD, PhD, FASGE, Takao Itoi, MD, PhD, FASGE VideoGIE Volume 3, Issue 3, Pages 91-93 (March 2018) DOI: 10.1016/j.vgie.2017.12.008 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Enhanced CT abdominal image (A, axial; B, coronal) showing impacted stone in pancreatic head with tail-side dilation of main pancreatic duct. The stone is 16 mm in maximum diameter. Pancreatic parenchyma is swelling with an increase in soft tissue density circumference of pancreas. VideoGIE 2018 3, 91-93DOI: (10.1016/j.vgie.2017.12.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 (A) ERCP views showing impacted pancreatic stone (yellow arrow) and stricture in the pancreatic head and (B) advancement of 0.025-inch guidewire upstream to the stone and stricture. After endoscopic pancreatic sphincterotomy, 5F Soehendra stent retriever advanced over the guidewire, 7F × 15cm pancreatic plastic was deployed (C). VideoGIE 2018 3, 91-93DOI: (10.1016/j.vgie.2017.12.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Digital pancreatoscopic image showing large whitish pancreatic duct stone (A), which was shattered by electrohydraulic lithotripsy (B, C). VideoGIE 2018 3, 91-93DOI: (10.1016/j.vgie.2017.12.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 (A, B) Shattered pancreatic stones (yellow arrow) were seen endoscopically. Fragment and stone extraction and sweeping performed by use of Tetra Catch and Flower Catch. VideoGIE 2018 3, 91-93DOI: (10.1016/j.vgie.2017.12.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions