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

Area of Science:

• Gastroenterology
• Interventional Endoscopy

Background:

• Biliary cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP) presents challenges.
• Existing techniques include double-guidewire, needle-knife sphincterotomy, EUS-guided rendezvous, and traction assistance.

Purpose of the Study:

• To describe a novel application of a cholangioscopy miniforceps tool for traction-assisted biliary cannulation.
• To highlight its utility in cases of difficult cannulation, specifically with a floppy major papilla.

Main Methods:

• A traction-assisted technique was employed using a cholangioscopy miniforceps in conjunction with the double-guidewire method.
• This approach was applied to a patient with biliary obstruction secondary to a hilar mass.

Main Results:

• Successful biliary cannulation was achieved.
• Cholangioscopy enabled biopsies and brushings for histologic diagnosis.
• Three plastic stents were successfully placed for biliary decompression.

Conclusions:

• Traction-assisted cannulation with miniforceps is a viable option for difficult ERCP procedures.
• This technique is particularly beneficial when encountering redundant periampullary mucosa.