SUCCESSFUL BILE DUCT CANNULATION OF AN INTRADIVERTICULAR PAPILLA USING THE MULTI-LOOP TRACTION DEVICE^TM AFTER ROUX-EN-Y RECONSTRUCTION

Abstract

We aimed to perform ERCP using single-balloon endoscopy (SBE-ERCP) in a 78-year-old man with acute obstructive suppurative cholangitis due to common bile duct stones. He had already undergone Roux-en-Y reconstruction for gastric cancer. The bile duct cannulation was technically challenging due to a duodenal diverticulum whose papilla was located on the anal side. Thus, we used the Multi-loop traction device^TM (MLTD), which is used for endoscopic submucosal dissection, during the SBE-ERCP. An endoscopic clip was deployed with the MLTD to the duodenal mucosa on the anal side of the diverticulum. The endoscopic clip was hooked in the MLTD and pulled toward the anal side. Subsequently, the clip was attached to the ipsilateral duodenal mucosa. Finally, the papilla position was corrected to allow bile duct cannulation and plastic stent placement. The present study demonstrates the utility of MLTD for bile duct cannulation in patients with parapapillary diverticula after gastrointestinal tract reconstruction.