Management of pancreatic stones associated with chronic pancreatitis is challenging and requires a multidisciplinary approach. The usefulness of electronic hydraulic lithotripsy (EHL) through peroral pancreatoscopy (POPS) was recently described in several reports [1] [2] [3] [4]. However, the electronic hydraulic shock applied during EHL may cause the stones to float into the dilated main pancreatic duct before fragmentation is achieved. Then the stone may be pushed deeply into the pancreatic tail, resulting in its incarceration there or the development of obstructive pancreatic ductitis. We present a case in which a basket catheter was used to hold the pancreatic stone in a stable position, allowing the successful performance of EHL through POPS.

An 85-year-old man with chronic pancreatitis developed pleural effusion and abdominal accumulation of pancreatic fluid originating from a pancreatic fistula secondary to a stone within the pancreatic head ([Fig. 1]). Using a transpapillary approach, we placed a plastic stent beyond the stone. After improvement of the pancreatic fistula, we attempted to crush the stone by EHL with POPS. However, this procedure was insufficient because of the hardness of the stone, and the applied electrohydraulic shock caused the intact stone to float in the direction of the pancreatic tail ([Fig. 2]). A basket catheter was inserted to grasp the stone, and disassembled. Then the scope was removed, leaving the basket within the pancreatic duct. We reinserted the duodenoscope and pancreatoscope, followed by resumption of EHL to crush the stone as it was held in a stable position by the basket ([Fig. 3] and [Video 1]). After complete fragmentation, the basket catheter was removed, and the stone fragments were successfully swept up with a microbasket through the pancreatoscope.