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Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla
Kanglock Lee,Ji Wook Choi,Yunhyeong Lee,Joung-Ho Han,Seon Mee Park 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.1
Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile ductstones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with atrial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o’clock. Eversion andfixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved afterendoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest thatsubmucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is verydiffcult because of an intradiverticular papilla.