EUS guided fine needle fragmentation (EUS-FNF) for the treatment of difficult biliary stones; a novel therapeutic indication for EUS. A case report with images

Methods A lady (65y) presented with abdominal pain and jaundice. The liver enzymes, ALP and bilirubin were elevated. MRCP showed Mirrizi’s syndrome Type I. An impacted stone in the cystic duct was obstructing a very short common hepatic duct and the intrahepatic biliary tree. A cholangiogram in the laparoscopic cholecystectomy with intraoperative ERCP confirmed the MRCP finding. The surgeon was unable to mobilize the stone out of the cystic duct. A transcystic guide wire was provided to an ERCPst and a balloon was introduced to the cystic duct by the ERCPst. The stone could not be mobilized to the common bile duct. The cystic stone was left and the bile duct was stented with a plastic stent.