Electrohydraulic lithotripsy to treat retrieval net impaction during balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography.

A 55-year-old woman who had undergone extrahepatic bile duct resection and choledochojejunostomy for pancreatobiliary maljunction was admitted to our hospital with acute cholangitis caused by large intrahepatic bile duct stones. We performed direct peroral cholangioscopy using a double-balloon endoscope. After fragmenting the stones with a snare under direct visualization, we attempted to remove them using a retrieval net, which led net impaction. To address this, we inserted the electrohydraulic lithotripsy probe-known for its lack of rigidity-into the working channel via an endoscopic retrograde cholangiopancreatography catheter, enabling electrohydraulic lithotripsy under direct visualization, without scope removal, and complete stone removal. This case demonstrated successful stone dislodgement with electrohydraulic lithotripsy, highlighting an innovative probe insertion method. Owing to the complexity of balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography, more careful instrument selection is crucial than in conventional endoscopic retrograde cholangiopancreatography. Electrohydraulic lithotripsy proved to be effective in managing stone impaction during balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography.