Retrograde double-balloon endoscopy-assisted electrohydraulic lithotripsy: Effective treatment of a true-enterolith associated with Crohn's disease.

A 42-year-old man with a history of Crohn’s disease was referred for treatment of an enterolith. The patient had no symptoms such as abdominal pain or nausea. Abdominal X-ray and computed tomography (CT) scan showed a 2.8-cm enterolith in the ileum ([Fig. 1], [Fig. 2]). Intestinal stenosis was found 10 cm proximal from the Bauhin’s valve with an enterolith on the proximal side of the stenosis ([Fig. 3]). The stenosis was dilated with a balloon catheter. Because the enterolith often moved into the oral side of the intestinal tract, retrograde double-balloon endoscopy (DBE) was performed using an EI-580BT endoscope (Fujifilm, Tokyo, Japan). We tried to crush the stone using biopsy forceps, polypectomy snares and crusher catheters, but the stone was too hard and none were effective. Surgery or electrohydraulic lithotripsy (EHL) were suggested as treatment options, and the patient chose EHL. We surrounded the stone with water, and EHL was performed ([Video 1]). The stone gradually cracked and fragmented into pieces ([Fig. 4]). We removed it using a disposable loop net ([Fig. 5]). Calculus analysis revealed that the main component of the enterolith was calcium oxalate, which indicates that the stone was a true-enterolith.