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
Fig. 1 The papilla was grasped with small biopsy forceps and pulled toward the anal side.
The cannula was then inserted into the bile duct using the wire-guided cannulation
method.
Fig. 2 Fluoroscopic image showing bile duct cannulation performed using the two devices in
one channel method in the push position.
Fig. 3 Placement of a metal stent (Dumbbell ComVi, 10 mm × 6 cm; Century Medical).
The new duodenoscope has a larger working channel and is well-suited for the 2D-1C
technique.
Endoscopy_UCTN_Code_TTT_1AR_2AC
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