Endoscopic Biliary Intervention Using Traction Devices for Periampullary Diverticulum

Abstract

We describe the case a 92-year-old woman who was admitted to our hospital with choledocholithiasis and periampullary diverticulum (PAD). Due to PAD, clear visualization of the ampulla of Vater could not be obtained. Although selective bile duct cannulation was difficult, a 7-Fr plastic stent was placed during the first session. Fifteen days later, endoscopic retrograde cholangiopancreatography was retried using traction devices, and the papilla became visible. Endoscopic sphincterotomy and stone extraction were performed without any complications. The application of traction devices in endoscopic submucosal dissection may be a promising technique in cases in which endoscopic biliary intervention is difficult due to PAD.

Usefulness of a papilla fixation method with an innovative clipping system for bile duct cannulation

“…Unlike conventional endoclips, the Sure-Clip is a device that can be easily used for clipping even when the forceps elevator of the duodenoscope is lifted. Previous reports have shown that the visi-bility of an intradiverticular papilla was improved when endoclips were used [3][4][5], but this is the first report in which the papilla was fixed and a long narrow distal segment was stretched using this newly designed clipping system. This method is simple and useful in cases where the papilla is unstable.…”

A traction device to aid the intubation of a surgically altered bile duct during ERCP

“…Cases of difficult CBD intubation during ERCP have been reported 1 . The traction device (S-O clip) can also be used in complex cases with diverticular papillae during conventional ERCP 2 . CBD intubation using this device for diverticular papilla in Roux-en-Y reconstruction has also been reported 3 .…”

Multiloop traction method during endoscopic hemostasis for post-sphincterotomy bleeding of the peridiverticular papilla

“…Periampullary diverticulum (PAD) is considered a risk factor for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) because it makes the papilla unidentifiable 1 . Applying a traction force near the papilla has been reported to be effective in PAD biliary interventions 2 . We report a successful case of endoscopic hemostasis in post-sphincterotomy bleeding, using the multiloop traction method (M-loop method), in a patient with PAD 3 ( Video 1 ).…”