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DOI: 10.1055/s-0029-1215276
© Georg Thieme Verlag KG Stuttgart · New York
Use of an ultrathin gastroscope to locate a papilla hidden within a duodenal diverticulum
J. García-Cano
Department of Digestive Diseases
Hospital Virgen de la Luz
16002 Cuenca
Spain
Email: j.garcia-cano@terra.es
Publication History
Publication Date:
05 March 2010 (online)
A 67-year-old-woman was referred because of failure to locate the papilla of Vater on endoscopic retrograde cholangiopancreatography (ERCP). The patient had undergone cholecystectomy several years ago, and presently she had been diagnosed as having common bile duct stones that were causing colicky pain. A repeat ERCP revealed a duodenal diverticulum in the region where the papilla was expected to be ([Fig. 1]).
It was thought that the papillary orifice was hidden within the diverticulum. Several maneuvers were tried to evert the papilla, such as using two devices simultaneously [1] around the entire rim of the diverticulum, but without success. Thus the duodenoscope was withdrawn and an ultrathin gastroscope inserted (Pentax EG-1870K, Pentax, Tokyo, Japan) with an outer diameter of 6 mm. The diverticulum was carefully intubated and explored ([Fig. 2]) but the papillary orifice was still not found.
Consequently, the inner surface of the diverticulum border was thoroughly examined. The ultrathin gastroscope was passed several times around the border of the diverticulum toward the duodenal lumen in an attempt to evert the rim and locate the papillary orifice. Finally the orifice was found on the left side of the diverticulum border in the endoscopic view. The ultrathin gastroscope was withdrawn and the duodenoscope reinserted. Biliary cannulation was accomplished in a standard fashion ([Fig. 3]).
ERCP confirmed the presence of stones in the common bile duct ([Fig. 4]).
Because of the altered regional anatomy, only a small biliary sphincterotomy could be carried out and balloon dilatation up to 18 mm was done, and the stones extracted. No complications occurred after the intervention.
Ultrathin endoscopes are increasingly used for many purposes [2] besides unsedated upper endoscopy [3]; their use in ERCP and biliary procedures has been also reported [4] [5]. In the present case, the ultrathin endoscope allowed thorough and safe inspection from within the duodenal diverticulum as well as therapeutic ERCP.
Endoscopy_UCTN_Code_TTT_1AR_2AB
#References
- 1 García-Cano J. ERCP cannulation of a hidden papilla within a duodenal diverticulum. Endoscopy. 2008; 40 Suppl 2 E53
- 2 García-Cano J. Use of an ultrathin gastroscope to allow endoscopic insertion of enteral wallstents without fluoroscopic monitoring. Dig Dis Sci. 2006; 51 1231-1235
- 3 Mulcahy H E, Riches A, Kiely M. et al . A prospective controlled trial of an ultrathin versus a conventional endoscope in unsedated upper gastrointestinal endoscopy. Endoscopy. 2001; 33 311-316
- 4 Yan S-L, Chen C-H, Yeh Y-H. et al . Successful biliary stenting and sphincterotomy using an ultrathin forward-viewing endoscope. Endoscopy. 2009; 41 E59-E60
- 5 Mori A, Sakai K, Ohashi N. et al . Electrohydraulic lithotripsy of the common bile duct stone under transnasal direct cholangioscopy. Endoscopy. 2008; 40 E63
J. García-Cano
Department of Digestive Diseases
Hospital Virgen de la Luz
16002 Cuenca
Spain
Email: j.garcia-cano@terra.es
References
- 1 García-Cano J. ERCP cannulation of a hidden papilla within a duodenal diverticulum. Endoscopy. 2008; 40 Suppl 2 E53
- 2 García-Cano J. Use of an ultrathin gastroscope to allow endoscopic insertion of enteral wallstents without fluoroscopic monitoring. Dig Dis Sci. 2006; 51 1231-1235
- 3 Mulcahy H E, Riches A, Kiely M. et al . A prospective controlled trial of an ultrathin versus a conventional endoscope in unsedated upper gastrointestinal endoscopy. Endoscopy. 2001; 33 311-316
- 4 Yan S-L, Chen C-H, Yeh Y-H. et al . Successful biliary stenting and sphincterotomy using an ultrathin forward-viewing endoscope. Endoscopy. 2009; 41 E59-E60
- 5 Mori A, Sakai K, Ohashi N. et al . Electrohydraulic lithotripsy of the common bile duct stone under transnasal direct cholangioscopy. Endoscopy. 2008; 40 E63
J. García-Cano
Department of Digestive Diseases
Hospital Virgen de la Luz
16002 Cuenca
Spain
Email: j.garcia-cano@terra.es