ENDOSCOPIC PANCREATIC SPHINCTEROTOMY PLUS LARGE‐BALLOON DILATION FOR REMOVAL OF A LARGE IMPACTED PANCREATIC DUCT STONE (WITH VIDEO)

Pancreatic duct stones are a common complication of chronic pancreatitis. We describe successful endoscopic removal of a large pancreatic duct stone using large‐balloon dilation in combination with pancreatic sphincterotomy. A 63‐year‐old woman was admitted for endoscopic treatment of acute on chronic pancreatitis with diabetes and epigastric pain with liver dysfunction due to a large impacted stone within the distal main pancreatic duct. Endoscopic pancreatic sphincterotomy was carried out using a wire‐guided pull‐type sphincterotome. Although we could carry out a relatively large incision, the stone could not be extracted. We therefore carried out papillary dilation using a large balloon (diameter 12 to 15 mm) to make room alongside the stone. A 10 × 20‐mm white pancreatic duct stone was extracted during the process of pulling a dilating balloon into the working channel of the endoscope. Eventually, the second stone was removed without any procedure‐related complication.