Journal List > Korean J Gastroenterol > v.71(3) > 1007746

Kim, Lee, Kim, Kim, and Cho: The Usefulness of Cap-assisted Endoscopic Retrograde Cholangiopancreatography for Cannulation Complicated by a Periampullary Diverticulum

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 for-ward-viewing endoscopy were successfully used in 4 patients without major complications. Based on our experience, cap-fitted for-ward-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.

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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.
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Table 1.
Results of Cap-assisted ERCP in Patients with Difficult Cannulation due to Periampullary Diverticulam
kjg-71-168f2.tif
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