PMC9889859_01
Computed tomography scan of the patient's abdomen. (A,B) CT showing acute pancreatitis and large calculi in the pancreatic duct (white arrow).
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F1
Furthermore, multiple calcifications in the pancreas were also detected (Figures 1A,B).
ERCP progress. (A,B) Cannulation through the duodenal bulb to the main pancreatic duct under the guidance of the guidewire.
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F2
Cannulation was performed through the duodenum to the main pancreatic duct, and the guide wire was introduced into the pancreatic duct (Figures 2A,B).
Guide wire is inserted into the pancreatic duct, and a contrast agent is injected. (A) The guide wire was introduced to the pancreatic duct, multiple irregular filling defects in the pancreatic duct can be seen, and the pancreatic duct cavity appears narrow; (B) Cylindrical balloon dilatation for approximately 30 s.
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F3
When 38% of the contrast agent (meglumine diatrizoate) was injected, stones with a maximum diameter of approximately 1.5 cm * 1.2 cm were observed, multiple filling defects in the pancreatic duct and evident narrowing of the pancreatic duct at the head of the pancreas (Figure 3A). Endoscopic sphincterotomy (EST) and columnar balloon dilatation were performed for 30 s (Figure 3B).
Insert the SpyGlass into the pancreatic duct and operate. (A-D) Insertion of the SpyGlass into the pancreatic duct represents a view through the SpyGlass direct visualization system, which shows a large white stone in the main pancreatic duct. (E,F) Insertion of the U100 Plus EHL lithotripsy fibre through the working pipe to the surface of the stone for electrohydraulic lithotripsy was carried out.
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F4
Subsequently, after cylindrical balloon dilation was accomplished, SpyGlass was inserted under a guide wire's guidance (Figure 4A-D). White stones blocking the trunk of the pancreatic duct were seen, and the insertion of the U100 Plus EHL lithotripsy fibre through the working pipe to the stone's surface for Electrohydraulic lithotripsy was carried out, which allowed the large stones to be crushed (Figures 4E,F).
Stone removal process. (A,B) Removal of the stone of the pancreatic duct by a balloon. (C,D) Placement of a minimally invasive pancreatic duct pigtail stent.
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F5
Irrigation was performed through a dedicated channel, and the pancreatic duct was cleaned with a dilation balloon (Figures 5A,B). Ltd.] was performed, marking the end of the entire operative procedure (Figure 5C,D).