Rescuing impacted biliary extraction basket using cholangioscopy-directed lithotripsy and a pulley system
Bibliographic record
Abstract
Background and Aims: Impaction of a biliary extraction basket during endoscopic retrograde cholangiopancreatography (ERCP) is a rare but challenging adverse event. We describe a novel endoscopic rescue approach using cholangioscopy-guided lithotripsy and an improvised pulley system to remove an impacted biliary basket after failed transoral mechanical lithotripsy. Methods: A 52-year-old man presented with obstructive jaundice because of a 9-mm common bile duct stone. Initial ERCP with mechanical lithotripsy using an extraction basket resulted in basket impaction. Rescue lithotripsy with a transoral lithotriptor resulted in wires fracturing at the handle. Rescue endoscopic management of the impacted basket was performed at our center. The patient had significant duodenal ulceration due to tension from the exposed basket wires. Results: Cholangioscopy-directed electrohydraulic lithotripsy was performed to fracture the entrapped stone. An improvised pulley mechanism using grasping forceps as a fulcrum was used to successfully extract the entrapped basket. The patient was discharged within 48 hours without requiring surgical interventions. Conclusions: Cholangioscopy-guided lithotripsy is effective for releasing impacted baskets from entrapped stones. A pulley technique using grasping forceps can enable safe basket extraction by altering the vector of wire traction. This strategy provides a minimally invasive solution for managing an impacted biliary extraction basket.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".