Case Report
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World J Gastrointest Endosc. Nov 16, 2011; 3(11): 231-234
Published online Nov 16, 2011. doi: 10.4253/wjge.v3.i11.231
New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method
Yuji Sakai, Takeshi Ishihara, Toshio Tsuyuguchi, Katsunobu Tawada, Masayoshi Saito, Jo Kurosawa, Ryo Tamura, Seiko Togo, Rintaro Mikata, Motohisa Tada, Osamu Yokosuka
Yuji Sakai, Takeshi Ishihara, Toshio Tsuyuguchi, Katsunobu Tawada, Masayoshi Saito, Jo Kurosawa, Ryo Tamura, Seiko Togo, Rintaro Mikata, Motohisa Tada, Osamu Yokosuka, Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
Author contributions: Sakai Y, Ishihara T and Tsuyuguchi T were responsible for manuscript preparation; Sakai Y wrote the paper and performed endoscopic treatment; Tawada K, Saito M, Kurosawa J, Tamura R, Togo S, Mikata R and Tada M were responsible for data collection; Yokosuka O reviewed this manuscript.
Correspondence to: Yuji Sakai, MD, Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba, 260-8670, Japan. sakai4754@yahoo.co.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: January 17, 2011
Revised: October 2, 2011
Accepted: October 9, 2011
Published online: November 16, 2011
Abstract

The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis. Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice, endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus. Pancreatogram was slightly and insufficiently obtained by injecting the contrast media via the common channel of the duodenal main papilla. We tried to cannulate selectively into the pancreatic duct for a clear image. However, the selective cannulation of the pancreatic duct was difficult because of instability of the papilla. On the other hand, selective cannulation of the bile duct was relatively easily achieved. Therefore, after the imaging of the bile duct, a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted. As a result, selective pancreatic duct cannulation became possible. It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is difficult (“selective pancreatic duct difficult cannulation case”).

Keywords: Endoscopic retrograde cholangiopancreatography; Bile duct guidewire-indwelling method; Selective pancreatic duct cannulation; Endoscopic pancreatic sphincterotomy; Pancreatic duct guidewire-indwelling method