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KMID : 1038120190520010083
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Clinical Endoscopy
2019 Volume.52 No. 1 p.83 ~ p.86
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Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla
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Lee Kang-Lock
Choi Ji-Wook
Lee Yun-Hyeong
Han Joung-Ho
Park Seon-Mee
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Abstract
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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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KEYWORD
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Cholangiopancreatography, endoscopic retrograde, Gallstones, Ampulla of Vater, Intradiverticular papilla, Submucosal injection
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