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Hirofumi Harima,Kouichi Hamabe,Fusako Hisano,Yuko Matsuzaki,Tadahiko Itoh,Kazutoshi Sanuki,Isao Sakaida 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6
An 89-year-old man was referred to our hospital for treatment of hepatolithiasis causing recurrent cholangitis. He had undergone a priorWhipple procedure. Computed tomography demonstrated left-sided hepatolithiasis. First, we conducted peroral direct cholangioscopy(PDCS) using an ultraslim endoscope. Although PDCS was successfully conducted, it was unsuccessful in removing all the stones. Thestones located in the B2 segment were diffcult to remove because the endoscope could not be inserted deeply into this segment due to thesmall size of the intrahepatic bile duct. Next, we substituted the endoscope with an upper gastrointestinal endoscope. After positioningthe endoscope, the SpyGlass digital system (SPY-DS) was successfully inserted deep into the B2 segment. Upon visualizing the residualstones, we conducted SPY-DS-guided electrohydraulic lithotripsy. The stones were disintegrated and completely removed. In cases ofPDCS failure, a treatment strategy using the SPY-DS can be considered for patients with hepatolithiasis after a Whipple procedure.