SpyBite forcep- assisted biliary cannulation in patients with periampullary diverticula

Periampullary diverticula are common, occurring in up to 20% of patients undergoing ERCP. They are a major factor for difficult cannulation. Statistics show a success rate of 61 – 95% in such cases. Many strategies have been developed to overcome unsuccessful cannulation: double-wire technique, endoclip-assisted technique, precut papillotomy of fistulotomy etc.

Here we report a case of a 70-year old woman with a locally advanced pancreatic head cancer, referred to our clinic for a biliary stenting due to progressive icterus. The initial duodenoscopy found the papilla on the edge of periampullary diverticula with ostium inverted to the diverticulum (type IIa according to Li Tanaka classification). Several attempts for cannulation have failed. Proper scope placement was additionally troubled by a tumor infiltration of the duodenum. A Spy Bite forceps was inserted through the working channel together with the sphincterotome. The forceps was used to grasp the mucosa and facilitate access to the papilla, followed by successful cannulation. A 60mm partially covered stent was placed and effective biliary drainage was provided. Clinical improvement of the patient was established with both laboratory tests and US imaging.

SpyBite forcep-assisted technique is an unpopular but effective strategy for accessing the papilla in difficult cases. Additional advantages of the technique are its safety and agility.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025