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Endoscopy-guided laser lithotripsy for a difficult-to-crush enterolith
VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Endoscopy-guided laser lithotripsy for a difficult-to-crush enterolith
Figure 1. A calcified enterolith in the rectum.
A 64-year-old woman was referred to our hospital for the treatment of an enterolith that was identified during preoperative screening for breast cancer. Although she had no defecation disorders, she requested treatment because the enterolith could not be naturally discharged. CT of the abdomen revealed the enterolith with calcification in the rectum, and no other abnormality (Fig. 1). We obtained written informed consent to perform endoscopic therapy with the patient under conscious sedation, which was minimally invasive to the patient. However, we could not grasp the enterolith using a mechanical lithotripter because of the large size. Furthermore, the surface calcification could not be crushed even though we used alligator forceps, argon plasma coagulation, and a highfrequency needle-knife used for endoscopy. Subsequently, endoscopy-guided laser lithotripsy (Ho:YAG laser delivered through a fiber measuring 400 mm in diameter, with energy levels set at 20 W) was used to bore a hole in the enterolith (Video 1, available online at www.giejournal.org). We found that only the outer shell was calcified, whereas the internal contents comprised soft material suggestive of inspissated stool. A guidewire was passed through the hole and used to position a dilation balloon catheter in the hole, after www.giejournal.org
which the enterolith was fragmented by balloon inflation (Video 2, available online at www.giejournal.org). Finally, we used snare forceps to divide the fragments into smaller pieces and net forceps to recover them. No adverse event was observed during the endoscopic procedure. Analysis of the enterolith showed fatty acid calcium and other unknown components.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Takao Nishikawa, MD, Toshio Tsuyuguchi, MD, PhD, Hiroshi Ohyama, MD, Yuto Watanabe, MD, Hirotaka Koseki, MD, Yuji Sakai, MD, PhD, Harutoshi Sugiyama, MD, PhD, Dai Sakamoto, MD, Soichiro Kiyono, MD, PhD, Masato Nakamura, MD and Osamu Yokosuka, MD, PhD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan http://dx.doi.org/10.1016/j.gie.2014.01.028
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
Endoscopy-guided laser lithotripsy for a difficult-to-crush enterolith
Figure 1. A calcified enterolith in the rectum.
A 64-year-old woman was referred to our hospital for the treatment of an enterolith that was identified during preoperative screening for breast cancer. Although she had no defecation disorders, she requested treatment because the enterolith could not be naturally discharged. CT of the abdomen revealed the enterolith with calcification in the rectum, and no other abnormality (Fig. 1). We obtained written informed consent to perform endoscopic therapy with the patient under conscious sedation, which was minimally invasive to the patient. However, we could not grasp the enterolith using a mechanical lithotripter because of the large size. Furthermore, the surface calcification could not be crushed even though we used alligator forceps, argon plasma coagulation, and a highfrequency needle-knife used for endoscopy. Subsequently, endoscopy-guided laser lithotripsy (Ho:YAG laser delivered through a fiber measuring 400 mm in diameter, with energy levels set at 20 W) was used to bore a hole in the enterolith (Video 1, available online at www.giejournal.org). We found that only the outer shell was calcified, whereas the internal contents comprised soft material suggestive of inspissated stool. A guidewire was passed through the hole and used to position a dilation balloon catheter in the hole, after www.giejournal.org
which the enterolith was fragmented by balloon inflation (Video 2, available online at www.giejournal.org). Finally, we used snare forceps to divide the fragments into smaller pieces and net forceps to recover them. No adverse event was observed during the endoscopic procedure. Analysis of the enterolith showed fatty acid calcium and other unknown components.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Takao Nishikawa, MD, Toshio Tsuyuguchi, MD, PhD, Hiroshi Ohyama, MD, Yuto Watanabe, MD, Hirotaka Koseki, MD, Yuji Sakai, MD, PhD, Harutoshi Sugiyama, MD, PhD, Dai Sakamoto, MD, Soichiro Kiyono, MD, PhD, Masato Nakamura, MD and Osamu Yokosuka, MD, PhD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan http://dx.doi.org/10.1016/j.gie.2014.01.028
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1