Endoscopic retrograde cholangiopancreatography (ERCP) is an invaluable procedure for managing biliopancreatic disorders. Successful side-viewing scope insertion into the descending part of the duodenum is the first step in ERCP. However, delivering the side-viewing scope into the descending part of the duodenum is difficult in some patients with a cascade stomach, as the scope is stomach. insertion of a side-viewing scope in such patients may tear the gastric mucosa and result in gastric perforation and bleeding due to excessive shearing force on the gastric wall. 1,2 To overcome this problem, we used a large-diameter overtube designed for colonoscopy in patients in whom side-viewing scope insertion into the descending part of the duodenum was difficult due to a cascade stomach.An 88-year-old man who had required biliary stent insertion for acute cholangitis caused by bile duct stones 2 months prior was admitted to our hospital for removal of the biliary stent and bile duct stones. However, scope insertion into the descending part of the duodenum using a side-viewing endoscope (TJF-260V; Olympus, Tokyo, Japan) during ERCP was difficult
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