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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25097369
DOI: 10.1055/a-2509-7369
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Use of the mini-forceps traction-assisted cannulation technique when standard ERCP methods fail: Single-center retrospective study

Ankit Mishra 
1   Department of Internal Medicine, University of Michigan, Ann Arbor, United States (Ringgold ID: RIN1259)
,
Charles Meade
2   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, United States (Ringgold ID: RIN1259)
,
Allison R. Schulman
2   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, United States (Ringgold ID: RIN1259)
,
George Philips
2   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, United States (Ringgold ID: RIN1259)
,
Jorge D. Machicado
2   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, United States (Ringgold ID: RIN1259)
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Abstract

Background and study aims

There are few salvage techniques for achieving biliary cannulation when no duct can be accessed.

Patients and methods

We retrospectively reviewed 10 consecutive cases in which the mini-forceps traction-assisted cannulation technique (MFTAC) was used after failure of any duct access during endoscopic retrograde cholangiopancreatography (ERCP). Outcomes included technical success, use of adjunct techniques; time to biliary access; and adverse events (AEs).

Results

Most patients had a native papilla (n = 9) of peri-diverticular location (n = 5) and a benign indication (n = 6). Standard cannulation was unsuccessful over 8:23 mm:ss (interquartile range [IQR] 6:04–19:43). MFTAC had 100% technical success, achieved biliary access after 17:38 mm:ss (IQR 8:52–20:31), and had a 10% incidence of AEs (post-ERCP pancreatitis). MFTAC was sufficient to allow biliary cannulation in three cases and allowed pancreatic duct access in seven cases, which then allowed biliary cannulation with double-wire technique (5/10) and transpancreatic septotomy (2/10).

Conclusions

MFTAC is a feasible salvage approach for biliary access when standard cannulation methods fail.

Keywords

Pancreatobiliary (ERCP/PTCD) - Diagnostic ERC - ERC topics - Cholangioscopy


Publication History

Received: 26 September 2024

Accepted after revision: 05 December 2024

Accepted Manuscript online:
02 January 2025

Article published online:
29 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Bibliographical Record
Ankit Mishra, Charles Meade, Allison R. Schulman, George Philips, Jorge D. Machicado. Use of the mini-forceps traction-assisted cannulation technique when standard ERCP methods fail: Single-center retrospective study. Endosc Int Open 2025; 13: a25097369.
DOI: 10.1055/a-2509-7369
 

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