1692 Retrieval of Impacted Extraction Balloon: A Rare Complication of ERCP for Choledocholithiasis

INTRODUCTION: ERCP is an essential tool in the management of biliary disorders. A large variety of rare ERCP related complications have been reported such as an impacting a retrieval basket, and colonic perforation. We report an unusual complication of ERCP with a retained balloon and a successful endoscopic removal at subsequent ERCP. CASE DESCRIPTION/METHODS: A 61-year-old man was transferred from a local hospital after undergoing an ERCP for choledocholithiasis. The ERCP balloon became lodged in the bile duct during stone extraction. The endoscopist tried to retrieve the balloon by pulling on the external part of the balloon catheter, but the catheter broke. He aborted the procedure and removed the ERCP scope by cutting the balloon catheter from outside and pulled the scope out. The patient was left intubated with the balloon catheter in his mouth and was transferred to our facility. Upon arrival, the patient was taken for ERCP. A fluoroscopic film showed the extraction balloon in the right upper quadrant of the abdomen (Figure 1). The duodenoscope was introduced through the mouth next to the balloon catheter. The impacted balloon was seen emerging from the major papilla (Figure 2). It was compressing the upper ampulla, duodenum, and stomach leading to linear pressure erosions (Figure 2). We used the Spyglass direct visualization system ((Boston Scientific, Marlborough, Mass, USA) to visualize the balloon impaction site, which was obstructed by the balloon catheter and the stone (Figure 3). The bile duct was then cannulated using a 0.025-inch × 270 cm angled ERCP guidewire (Olympus VisiGlide) through a 3.9 Autotome sphincterotome (Boston Scientific). The CBD was moderately and diffusely dilated. The impacted balloon catheter was pulled using the external part of the catheter, and it was successfully removed. We placed one fully covered self-expandable metal stent (FCSEMS) (Wallflex, Boston Scientific)10 mm by 4 cm with one 7 Fr by 10 cm double pigtail plastic stent into the CBD to maintain adequate drainage. The ERCP was accomplished without difficulty. The patient was extubated, liver function test improved. He was discharged home in a stable condition. He will have repeated ERCP in 8 weeks to remove the stents. DISCUSSION: Retaining ERCP balloon during stone extraction is extremely rare because it is easy to deflate and remove. Up to our knowledge, it has not been reported in the literature. We have demonstrated a successful retrieval of retained ERCP balloon during stone extraction. Watch the video: http://bit.ly/2JUie2Q.