Korean J Gastrointest Endosc.  2001 Jul;23(1):53-55.

A Novel Approach for Cannulation of the Ampulla within a Diverticulum: A Two-Catheter Method

Affiliations
  • 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. mhkim@www.amc.seoul.kr

Abstract

An ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Eventually a successful cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully.

Keyword

Diverticulum; Ampulla; Cannulation; Two-catheter method

MeSH Terms

Aged
Catheterization*
Catheters
Cholangiopancreatography, Endoscopic Retrograde
Diverticulum*
Drainage
Humans
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