'Double guidewire in one catheter' method for a difficult endoscopic retrograde cholangiopancreatography cannulation (with video)

摘要

An 80-year-old man who had undergone distal pancreatec-tomy for pancreatic body cancer 2 weeks prior presented with abdominal abscess adjacent to the margins of the remnant pancreas. Pancreatic fistula was suspected and endoscopic retrograde cholangiopancreatography (ERCP) was attempted to insert a pancreatic stent. An uneven double-lumen catheter (Piolax, Yokohama, Japan),which has a 0.025-inch lumen at the tip of catheter and a 0.035-inch lumen 5 mm proximal from the tip, was used for cannulation. Pancreatic duct cannulation could not be achieved due to the remarkable instability of the duodenal papilla, but the bile duct was accessible. A guidewire (0.025 inch; Olympus, Tokyo, Japan) was retained in the bile duct to immobilize the papilla and the catheter was partially withdrawn from in front of the ampullary orifice without being fully removed. A second guidewire was loaded and aimed below and to the right of the first guidewire. Successful pancreatic duct cannulation was achieved easily (Fig. 1). After introducing the second guidewire to the duct of Santorini, a 5-Fr tube stent (Geenen; COOK, Winston Salem, NC, USA) was placed in the duct of Wirsung (Fig. 2) (Video S1).