Cannulation to the duodenal ampulla within the diverticulum is sometimes difficult.
A 91-year old man presented with acute cholangitis. ERCP was performed. The duodenal papilla was located within the diverticulum and the orifice of bile duct was not seen. When the papilla was pulled out of the diverticulum with the catheter tip, we could see the orifice. However, it returned to its original position soon after the catheter moved off and mechanical traction was withdrawn. Several attempts were made but failed. We therefore decided to use endoscopic clip to pull out the papilla outside the diverticulum and fix it onto the distal duodenal mucosa. After endoscopic clipping was successfully made, the orifice was clearly visible and the cannulation performed without difficulty.
Endoscopic clipping is one of the useful techniques to make the orifice visible and cannulate when a duodenal papilla is located within the diverticulum.
