Submucosal injection can facilitate biliary access in patients with periampullary diverticula

Harada, Hideaki; Suehiro, Satoshi; Shimizu, Takanori; Katsuyama, Yasushi; Hayasaka, Kenji

doi:10.1016/j.gie.2016.01.002

Cited by 5 publications

(13 citation statements)

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“…Several techniques have been introduced to facilitate cannulation in the setting of intradiverticular papilla (Table 1). 1,6,[9][10][11][12][13][14][15][16][17][18] To enable informed decisions and ensure the best outcomes, endoscopists should be aware of differences in technical feasibility and safety of each technique. The best method depends on the endoscopist' s preference and patient conditions.…”

Section: Discussionmentioning

confidence: 99%

“…The main goal of various techniques involves bringing the papilla into a better orientation by grasping, pushing, or lifting, or by performing pancreatic duct stenting. 7 Several different methods, such as submucosal injection, 6 endoscopic clipping, 9 two-devices-in-one-channel, 10 reverse guidewire anchoring, 11 double endoscopy, 12 cap-assisted with forward viewing endoscopy, 13 entering the duodenal diverticulum with the distal tip of the duodenoscope, 14 and pre-cut biliary sphincterotomy after pancreatic duct stent placement 1 have been introduced. Endoscopic clips are used to evert and stabilize the papillary opening.…”

Section: Discussionmentioning

confidence: 99%

“…Harada et al used sodium hyaluronate as an injection fluid for lifting of an intradiverticular papilla and successfully performed ERCP in five cases. 6 They performed endoscopic sphincterotomy (EST) and pancreatic stent placement to prevent post-ERCP pancreatitis. We preferred normal saline as the lifting material because papillary cannulation can be performed within several minutes before normal saline absorption.…”

Section: A B Cmentioning

confidence: 99%

“…5 Several techniques have been introduced to evert the papillary opening to facilitate cannulation. 1,[6][7][8][9][10][11][12][13][14][15] Submucosal injection, 6 endoscopic clipping, 9 and two-devices-in-one-channel, 10 have been introduced. The submucosal injection method involves lifting of the mucosa to enable eversion and fixing of a papilla in the diverticulum and allows selective cannulation of the biliary tree.…”

Section: Introductionmentioning

confidence: 99%

“…The submucosal injection method involves lifting of the mucosa to enable eversion and fixing of a papilla in the diverticulum and allows selective cannulation of the biliary tree. 6 This may be a safe and convenient technique and is easily performed in ordinary ERCP settings.…”

Section: Introductionmentioning

confidence: 99%

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Papillary Cannulation Facilitated by Submucosal Saline Injection Into the Intradiverticular Papilla

2019

ESGE Days 2019

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Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o' clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Papillary Cannulation Facilitated by Submucosal Saline Injection Into the Intradiverticular Papilla

2019

ESGE Days 2019

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Difficult Biliary Cannulation for Intradiverticular Papilla: Forceps Technique Revisited

et al. 2021

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Periampullary diverticula (PAD) have been encountered in 5.9 to 18.5% of patients during all the endoscopic retrograde cholangiopancreatography (ERCP). Cannulation in the presence of PAD can sometimes be difficult, time consuming, and often requires a higher level of endoscopic skills.Several techniques have been reported to facilitate and increase the chances of successful bile duct cannulation in the presence of PAD. The two-devices in one-channel method has been sparingly used. It involves the simultaneous use of a biopsy forceps and another instrument, either a cannula or sphincterotome through the same working channel. We successfully performed ERCP in three cases, where bile duct cannulation was performed in the setting of intradiverticular papilla using two-devices in one-channel method.We feel that the two-devices in one-channel method can be very useful and positioned higher up in the algorithm for successful cannulation in patients with PAD.

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Endoscopic Biliary Intervention Using Traction Devices for Periampullary Diverticulum

Inoüe¹,

Kawakami

Kubota

et al. 2019

Intern. Med.

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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.

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Submucosal injection can facilitate biliary access in patients with periampullary diverticula

Cited by 5 publications

References 0 publications

Papillary Cannulation Facilitated by Submucosal Saline Injection Into the Intradiverticular Papilla

Papillary Cannulation Facilitated by Submucosal Saline Injection Into the Intradiverticular Papilla

Difficult Biliary Cannulation for Intradiverticular Papilla: Forceps Technique Revisited

Endoscopic Biliary Intervention Using Traction Devices for Periampullary Diverticulum

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