Gastrointest Interv.  2018 Apr;7(1):34-35. 10.18528/gii160024.

Combined use of a two-channel endoscope and a flexible tip catheter for difficult biliary cannulation

• Kuwatani M
• Kubota Y
• Kawahata S
• Kubo K
• Kawakubo K
• Kawakami H
• Sakamoto N

• KMID: 2439203
• DOI: http://doi.org/10.18528/gii160024

Abstract

A 69-year-old woman with jaundice was referred to our hospital. After a final diagnosis of pancreatic cancer with liver metastasis, we performed transpapillary biliary drainage with a covered self-expandable metal stent (SEMS). Three months later, we also placed an uncovered duodenal stent for duodenal stricture in a side-to-end fashion. Another month later, for biliary SEMS obstruction, we attempted a transpapillary approach. A duodenoscope was advanced and a guidewire was passed through the mesh of the duodenal stent into the bile duct with a flexible tip catheter, but the catheter was not. Thus, we exchanged the duodenoscope for a forward-viewing two-channel endoscope and used the left working channel with a flexible tip catheter. By adjusting the axis, we finally succeeded biliary cannulation and accomplished balloon cleaning for recanalization of the SEMS. This is the first case with successful biliary cannulation by combined use of a two-channel endoscope and a flexible tip catheter.

Keyword

Bile duct obstruction; Catheters; Endoscopes

MeSH Terms

Aged
Bile Ducts
Catheterization*
Catheters*
Cholestasis
Constriction, Pathologic
Diagnosis
Drainage
Duodenoscopes
Endoscopes*
Female
Humans
Jaundice
Liver
Neoplasm Metastasis
Pancreatic Neoplasms
Stents