New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

Abstract

The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis. Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice, endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus. Pancreatogram was slightly and insufficiently obtained by injecting the contrast media via the common channel of the duodenal main papilla. We tried to cannulate selectively into the pancreatic duct for a clear image. However, the selective cannulation of the pancreatic duct was difficult because of instability of the papilla. On the other hand, selective cannulation of the bile duct was relatively easily achieved. Therefore, after the imaging of the bile duct, a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted. As a result, selective pancreatic duct cannulation became possible. It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is difficult ("selective pancreatic duct difficult cannulation case").

Reverse Double-Wire Cannulation of the Pancreatic Duct

“…3 In patients in whom PD cannulation may be difficult either because of stenosis, stones, or altered anatomy, the double-guidewire technique also may be used to facilitate quicker and atraumatic cannulation of the pancreatic duct, not only the common bile duct (CBD). 4 A guidewire loaded through a sphinctertome is used to cannulate the common bile duct. Once access is obtained and confirmed with selective contrast injection the sphincterotome is withdrawn, leaving the guidewire in the CBD.…”