Endoscopy 2018; 50(08): E229-E230
DOI: 10.1055/a-0624-9317
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A novel biliary cannulation method for difficult cannulation cases using a unique, uneven, double-lumen cannula (Uneven method)

Mamoru Takenaka
1   Department of Gastroenterology, Kobe University Faculty of Medicine, Hyogo, Japan
2   Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
,
Yoshifumi Arisaka
1   Department of Gastroenterology, Kobe University Faculty of Medicine, Hyogo, Japan
3   Department of Gastroenterology, Nissay Hospital, Osaka, Japan
,
Arata Sakai
1   Department of Gastroenterology, Kobe University Faculty of Medicine, Hyogo, Japan
,
Takashi Kobayashi
1   Department of Gastroenterology, Kobe University Faculty of Medicine, Hyogo, Japan
,
Hideyuki Shiomi
1   Department of Gastroenterology, Kobe University Faculty of Medicine, Hyogo, Japan
,
Atshuhiro Masuda
1   Department of Gastroenterology, Kobe University Faculty of Medicine, Hyogo, Japan
,
Masatoshi Kudo
2   Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
› Author Affiliations
Further Information

Corresponding author

Mamoru Takenaka, MD, PhD
Department of Gastroenterology and Hepatology
Kindai University Faculty of Medicine
377-2 Ohno-Higashi
Osaka-Sayama, 589-8511
Japan   
Fax: +81-72-3672880   

Publication History

Publication Date:
12 June 2018 (online)

 

The utility of pancreatic duct guidewire (P-GW) placement techniques, including the contrast-medium method and the contrast-free wire-guided cannulation method (i. e. the “double-guidewire method” [D-GW]), has been reported for selective biliary cannulation in patients in whom performing cannulation of the bile duct is difficult [1] [2] [3] [4] [5]. However, P-GW placement often disturbs the approach to the bile orifice. Moreover, it is sometimes difficult to insert the catheter or guidewire in the direction of the bile duct, which delays biliary cannulation.

Herein, we report a novel biliary cannulation method using a unique, uneven, double-lumen cannula (UDLC; PIOLAX, Tokyo, Japan). The UDLC is a double-lumen catheter, with lumens measuring 0.025 and 0.035 inches in diameter, respectively. The orifice of each lumen is uneven, thereby forming a channel at the tip of the UDLC ([Fig. 1]). With such characteristics in mind, we applied the UDLC to develop a new method of selective biliary cannulation for difficult cannulation cases (UDLC method). We describe a case wherein the UDLC was successfully employed without complications ([Video 1]).

Zoom Image
Fig. 1 The uneven double-lumen cannula (UDLC; PIOLAX, Tokyo, Japan) is a double-lumen catheter, with lumens of 0.025 (distal, a) and 0.035 (proximal, b) inches in diameter. The orifice of each lumen is uneven, thereby creating a channel within the tip.

Video 1 The uneven double-lumen cannula (UDLC) method is used for cases of difficult cannulation. The papilla is intubated using the UDLC, then biliary cannulation via the proximal lumen is quickly performed.


Quality:

A 75-year-old man presented with pancreatic cancer and was admitted to our hospital for treatment of obstructive cholangitis. It was difficult to perform biliary cannulation as we could insert only the P-GW. Initially, the UDLC was used to intubate the papilla through the P-GW via the distal lumen. This straightened the pancreatic duct and the common channel, thereby effectively stabilizing the papilla ([Fig. 2]). Next, we performed biliary cannulation via the proximal lumen, as is done in the D-GW method ( [Fig. 3]). By using this method, we were able to avoid the time delay in adjusting the catheter axis to comply with the bile duct direction, as required in the P-GW method. Thus, we easily initiated the biliary cannulation approach. Ultimately, we succeeded in performing selective biliary cannulation ([Fig. 4]).

Zoom Image
Fig. 2 A schematic of the uneven double-lumen cannula (UDLC) method. Initially, the UDLC a is intubated to the papilla through the pancreatic guidewire (P-GW) b using the distal lumen. This straightens the pancreatic duct and the common channel, thereby more effectively stabilizing the papilla compared with the use of the P-GW alone. Next, biliary cannulation using the proximal lumen is performed in a manner that is similar to the double-guidewire technique c.
Zoom Image
Fig. 3 The tip of the uneven double-lumen cannula a is intubated to the papilla through the pancreatic guidewire. The guidewire from the proximal lumen b is seen.
Zoom Image
Fig. 4 The uneven double-lumen cannula (UDLC) is intubated to the papilla through the pancreatic guidewire a. The fluoroscopic marker of the UDLC b is seen. The guidewire from the proximal lumen c is used for biliary cannulation, as is done in the double-guidewire method.

In summary, we report a new cannulation method using a UDLC to safely and effectively perform selective biliary cannulation in patients in whom biliary cannulation is otherwise difficult.

Endoscopy_UCTN_Code_CCL_1AZ_2AI

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Competing interests

None

  • References

  • 1 Dumonceau JM, Devière J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 1998; 30: S80
  • 2 Maeda S, Hayashi H, Hosokawa O. et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy 2003; 35: 721-724
  • 3 Ito K, Fujita N, Noda Y. et al. Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol 2008; 14: 5595-5600
  • 4 Herreros de Tejada A, Calleja JL, Diaz G. et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009; 70: 700-709
  • 5 Gronroos JM, Vihervaara H, Gullichsen R. et al. Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center. Surg Endosc 2011; 25: 1599-1602

Corresponding author

Mamoru Takenaka, MD, PhD
Department of Gastroenterology and Hepatology
Kindai University Faculty of Medicine
377-2 Ohno-Higashi
Osaka-Sayama, 589-8511
Japan   
Fax: +81-72-3672880   

  • References

  • 1 Dumonceau JM, Devière J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 1998; 30: S80
  • 2 Maeda S, Hayashi H, Hosokawa O. et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy 2003; 35: 721-724
  • 3 Ito K, Fujita N, Noda Y. et al. Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol 2008; 14: 5595-5600
  • 4 Herreros de Tejada A, Calleja JL, Diaz G. et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009; 70: 700-709
  • 5 Gronroos JM, Vihervaara H, Gullichsen R. et al. Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center. Surg Endosc 2011; 25: 1599-1602

Zoom Image
Fig. 1 The uneven double-lumen cannula (UDLC; PIOLAX, Tokyo, Japan) is a double-lumen catheter, with lumens of 0.025 (distal, a) and 0.035 (proximal, b) inches in diameter. The orifice of each lumen is uneven, thereby creating a channel within the tip.
Zoom Image
Fig. 2 A schematic of the uneven double-lumen cannula (UDLC) method. Initially, the UDLC a is intubated to the papilla through the pancreatic guidewire (P-GW) b using the distal lumen. This straightens the pancreatic duct and the common channel, thereby more effectively stabilizing the papilla compared with the use of the P-GW alone. Next, biliary cannulation using the proximal lumen is performed in a manner that is similar to the double-guidewire technique c.
Zoom Image
Fig. 3 The tip of the uneven double-lumen cannula a is intubated to the papilla through the pancreatic guidewire. The guidewire from the proximal lumen b is seen.
Zoom Image
Fig. 4 The uneven double-lumen cannula (UDLC) is intubated to the papilla through the pancreatic guidewire a. The fluoroscopic marker of the UDLC b is seen. The guidewire from the proximal lumen c is used for biliary cannulation, as is done in the double-guidewire method.