Clin Endosc.  2021 Jan;54(1):139-140. 10.5946/ce.2020.087.

A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis

• Kim KH
• Kim SB
• Kim TN

• KMID: 2512321
• DOI: http://doi.org/10.5946/ce.2020.087

Figure

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  Fig. 1. The endoscopic image using a cap-fitted forward-viewing endoscope shows a reversely oriented ampulla of Vater, which was not prominent. Cannulation attempts using a standard cannulation catheter with a straight tip failed because of the flat ampulla and tortuous bile duct.

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  Fig. 2. Gentle grasping of the lower margin of the ampulla and pulling the mucosa with an endobiliary forceps can enhance the stabilization of the ampulla and straighten the bile duct. Then, a 0.025-inch guidewire was manipulated carefully and cannulated successfully into the bile duct.

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  Fig. 3. The fluoroscopic image shows a 0.025-inch guidewire passing through the same working channel parallel to the endobiliary forceps grasping the lower margin of the ampulla.

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