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ERCP for intradiverticular papilla: two-devices-in-one-channel method. Endoscopic Retrograde Cholangiopancreatography
N Fujita1, Y Noda, G Kobayashi
1Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan.
Background:
The prevalence of biliopancreatic disorders is high in patients with periampullary diverticula. However, endoscopic retrograde cholangiopancreatography (ERCP) in patients with the papilla deep inside duodenal diverticula is difficult.
Methods:
Two patients were included in this study, each with the papilla deep inside a diverticulum and in whom an initial ERCP was unsuccessful. A biopsy forceps to pinch the duodenal mucosa distal to the papilla and pull the papilla out of the diverticulum and a cannula were inserted into the working channel of a duodenoscope together (the two-devices-in-one-channel method). With coordination of the two instruments, cannulation of the bile duct was attempted.
Results:
In both patients ERCP was successful using this procedure and no complications followed.
Conclusions:
The two-devices-in-one-channel method is useful when performing ERCP in patients with the papilla inside juxtapapillary diverticula.