2017 Volume 59 Issue 5 Pages 1329-1334
An 82-year-old female was admitted with right hypochondriac pain. Clinical findings, blood examination and computed tomography revealed that she had acute cholangitis. She underwent endoscopic retrograde cholangiopancreatography （ERCP） for biliary drainage. The major papilla was located at the inside of a diverticulum on the right side, and it was difficult to maintain an appropriate view of the papilla through the duodenoscope. Exchanging the duodenoscope with a forward-viewing endoscope enabled insertion of a plastic stent in the pancreatic duct and it made the papilla face outside of the diverticulum, allowing completion of biliary drainage. In our case, all procedures were feasible without highly invasive treatment and without special instruments including a sphincterotome. Exchange to a forward-viewing endoscope can be prioritized as an effective method in patients with parapapillary diverticulum.
