Korean J Gastroenterol.  2018 Mar;71(3):168-172. 10.4166/kjg.2018.71.3.168.

The Usefulness of Cap-assisted Endoscopic Retrograde Cholangiopancreatography for Cannulation Complicated by a Periampullary Diverticulum

• Kim J
• Lee JS
• Kim EJ
• Kim YS
• Cho JH

• KMID: 2407674
• DOI: http://doi.org/10.4166/kjg.2018.71.3.168

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced therapeutic procedure to manage choledocholithiasis and pancreatobiliary malignancy. On occasion, ERCP failure is encountered due to difficulties in cannulation. We assessed the safety and feasibility of cap-assisted ERCP via analyzing cases in which cannulation was complicated by periampullary diverticulum. Between November 2013 and March 2014, ERCP procedures were performed in 346 patients in our tertiary medical center. Among the 73 patients who had a periampullary diverticulum, conventional ERCP failed in 5 patients due to hidden papilla (n=3) or use of tangential approach (n=2). As a rescue method, needle knife fistulotomy and selective biliary cannulation using cap-fitted forward-viewing endoscopy were successfully used in 4 patients without major complications. Based on our experience, cap-fitted forward-viewing endoscopy was relatively easy to measure the exact position of papilla and to perform biliary cannulation properly. Therefore, we recommend using cap-assisted ERCP by forward-viewing endoscopy as a useful and safe alternative to manage patients in whom cannulation is complicated by periampullary diverticulum.

Keyword

Cap-assisted endoscopy; Endoscopic retrograde cholangiopancreatography; Diverticulum

MeSH Terms

Catheterization*
Cholangiopancreatography, Endoscopic Retrograde*
Choledocholithiasis
Diverticulum*
Endoscopy
Humans
Methods
Needles

Figure

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  Fig. 1. Biliary cannulation with cap-fitted forward-viewing endoscope in patients with periampullary diverticulum. (A) Biliary cannulation by side-viewing endoscope failed due to tangential approach toward papilla. (B) Observation of papilla and biliary cannulation with needle-knife infundibulotomy overcoming tangential approach by cap-fitted forward-viewing endoscope.

Reference

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