Forceps-Assisted Endoscope Rigidity Reinforcement for Difficult Duodenal Intubation due to Cascade Stomach

A 92-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholecystitis and bile duct stones. A cascade stomach caused significant difficulty in duodenal intubation, despite multiple standard maneuvers. As a large-diameter overtube was unavailable, forceps were inserted through the accessory channel to increase endoscope rigidity. This technique minimized scope looping and enabled duodenal access within 2 minutes. Biliary cannulation, sphincterotomy, and drainage were completed successfully. The same method was used in a subsequent ERCP with similar success. This case demonstrates that forceps-assisted rigidity reinforcement is a simple, effective, and equipment-free option for managing duodenal intubation difficulties during ERCP.