The forceps-assisted technique for difficult cannulation has been in widespread use since 1996

I read with great interest the report on the “forceps-assisted technique” for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP) by Borahma et al. [1]. They reported that the forceps-assisted technique is a new technique that involves the use of two devices in the same working channel to facilitate cannulation of the major duodenal papilla. However, this technique was originally reported by Tantau et al. in 1996 [2]. A biopsy forceps was used to trap the mucosa of the periampullary diverticulum and fix the papilla in front of the operating channel of the duodenoscope to facilitate biliary cannulation in a patient with a large duodenal diverticulum [2]. Fujita et al. later named this cannulation technique the “two-devices-in-one-channel method” and reported two successful cases [3]. Since then, this “two-devices-in-one-channel method” has been well established as a useful cannulation technique during ERCP, especially for patients with large periampullary diverticula [4] [5]. An algorithm of biliary cannulation techniques in ERCP for difficult cases because of a periampullary diverticulum [5] proposed applying the two-devices-in-one-channel method to increase the success rate of biliary cannulation. In Japan, this method is known to all endoscopists performing ERCP and is often used, even by trainees.

In conclusion, the “forceps-assisted technique” is not a new cannulation technique but has already been reported by Tantau et al. in 1996. Moreover, this useful technique is well known as the “two-devices-in-one-channel method” all over the world.

Publication History

Article published online:
29 March 2021

• References

• 1 Borahma M, Benelbarhdadi I, Berhili C. et al. Forceps-assisted technique: a new technique for difficult cannulation. Endoscopy 2020; 52: E247-E248
• 2 Tantau M, Person B, Burtin P. et al. Duodenal diverticula and ERCP: a new trick. Endoscopy 1996; 28: 326
• 3 Fujita N, Noda Y, Kobayashi G. et al. ERCP for intradiverticular papilla: two-devices-in-one-channel method. Gastrointest Endosc 1998; 48: 517-520
• 4 Parlak E, Köksal AS, Dişibeyaz S. et al. Additional biliary cannulation methods in patients with juxtapapillary duodenal diverticula. Dig Dis Sci 2012; 57: 2982-2987
• 5 Altonbary AY, Bahgat MH. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation. World J Gastrointest Endosc 2016; 8: 282-287