Clin Endosc.  2019 Jan;52(1):83-86. 10.5946/ce.2018.060.

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla

Affiliations
  • 1Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea. smpark@chungbuk.ac.kr
  • 2Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o'clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

Keyword

Cholangiopancreatography, endoscopic retrograde; Gallstones; Ampulla of Vater; Intradiverticular papilla; Submucosal injection

MeSH Terms

Aged
Ampulla of Vater
Bile Ducts
Biliary Tract
Catheterization*
Cholangiopancreatography, Endoscopic Retrograde
Diverticulum
Female
Gallstones
Humans
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr