Cholangioscopy miniforceps-assisted cannulation: another tool in the toolbox for difficult cannulation

Biliary cannulation during ERCP can be difficult for many reasons. Cannulation techniques include double-guidewire, needle-knife sphincterotomy, EUS-guided rendezvous, and traction assistance. We describe a case where the use of a cholangioscopy miniforceps tool allowed for traction-assisted cannulation of a floppy major papilla.

Traction assistance using a cholangioscopy miniforceps along with double-guidewire technique was used.

Successful biliary cannulation was achieved in a patient with biliary obstruction due to a hilar mass. This allowed for cholangioscopic examination with biopsies (using miniforceps) as well as brushings for histologic diagnosis. Three plastic stents were placed for decompression.

Traction-assisted technique using miniforceps should be considered in difficult ERCP cannulation, especially if redundant periampullary mucosa is encountered.