RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/a-2612-3614
Two devices in one channel procedure for difficult cannulation due to periampullary diverticulum using a new duodenoscope
Authors
The two devices in one channel (2D-1C) procedure have been reported as useful in cases of difficult cannulation due to a periampullary diverticulum [1] [2]. However, a limitation of this technique is that inserting two devices into the narrow working channel can reduce maneuverability. In this report, we describe the successful use of the 2D-1C procedure with a new duodenoscope (ED-840T, Fujifilm) featuring a larger 4.5-mm working channel than that of conventional duodenoscopes, resulting in improved maneuverability.
An 80-year-old woman undergoing chemotherapy for pancreatic cancer with liver metastasis was admitted to our hospital with obstructive jaundice and cholangitis. We attempted bile duct cannulation using the new duodenoscope and a catheter (MTW catheter; ABIS), but this was unsuccessful because of duodenal deformation caused by pancreatic head cancer and the presence of a periampullary diverticulum. As a result, we were only able to approach the papilla in the push position. We then attempted the 2D-1C procedure using small forceps (SpyBite Max; Boston Scientific Japan) ([Video 1]). Despite working in the push position – which typically increases friction between devices within the endoscope – we were able to insert both devices without resistance. The forceps were used to grasp the anal side of the papilla and push it toward the scope ([Fig. 1]). This allowed successful wire-guided cannulation of the bile duct using the catheter ([Fig. 2]). After performing endoscopic sphincterotomy, we put in place a metal stent (Dumbbell ComVi, 10 mm × 6 cm; Century Medical) ([Fig. 3]).
Two devices in one channel procedure for difficult cannulation due to periampullary diverticulum using a new duodenoscope.Video 1
The new duodenoscope has a larger working channel and is well-suited for the 2D-1C technique.
Endoscopy_UCTN_Code_TTT_1AR_2AC
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
Publikationsverlauf
Artikel online veröffentlicht:
02. Juli 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Gonzalez JM, Debourdeau A, Barthet M. How to facilitate cannulation of an intradiverticular papilla: a technique with two devices in one channel using pediatric forceps. Endoscopy 2019; 51: 1095-1096
- 2 Kaneko T, Sugimori K, Endo K. et al. Usefulness of the two-devices-in-one-channel technique for difficult bile duct intubation in patients without periampullary diverticulum. Endoscopy 2023; 55 (Suppl. 01) E76-E77