Difficult Biliary Cannulation for Intradiverticular Papilla: Forceps Technique Revisited

Abstract

Periampullary diverticula (PAD) have been encountered in 5.9 to 18.5% of patients during all the endoscopic retrograde cholangiopancreatography (ERCP). Cannulation in the presence of PAD can sometimes be difficult, time consuming, and often requires a higher level of endoscopic skills.

Several techniques have been reported to facilitate and increase the chances of successful bile duct cannulation in the presence of PAD. The two-devices in one-channel method has been sparingly used. It involves the simultaneous use of a biopsy forceps and another instrument, either a cannula or sphincterotome through the same working channel. We successfully performed ERCP in three cases, where bile duct cannulation was performed in the setting of intradiverticular papilla using two-devices in one-channel method.

We feel that the two-devices in one-channel method can be very useful and positioned higher up in the algorithm for successful cannulation in patients with PAD.

Keywords

periampullary diverticula - ERCP - two-devices in one-channel method - difficult biliary cannulation

Financial Support and Sponsorship

Nil.

Author Contributions

Mahesh Goenka was involved in conceptualization, methodology, supervision, writing, reviewing, and editing.

Gajanan Rodge was involved in visualization, data curation, writing, original draft preparation, and investigation.

Bhavik Shah and Shivaraj Afzalpurkar were involved in writing, reviewing, and editing of the manuscript.

Publikationsverlauf

Eingereicht: 03. September 2020

Angenommen: 15. April 2021

Artikel online veröffentlicht:
03. August 2021

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