VideoGIE
Clip-assisted biliary cannulation to expose papilla covered by lipoma
Figure 1. A, Duodenal lipoma hiding papilla of Vater. B, Clip in place to retract lipoma and expose papilla of Vater.
Selective biliary duct cannulation during ERCP can be problematic in patients with anatomic alterations and may fail in up to 5% of cases. The most frequent factors leading to difficult cannulation are impacted stones, periampullary diverticula, and previous surgical procedures. Juxtapapillary lipoma is a rare condition that may challenge biliary cannulation. In Video 1 (available online at www.giejournal.org), we describe how to manage a juxtapapillary lipoma to achieve deep biliary cannulation. Here, the lipoma hindered the papillary orifice and interfered with selective cannulation (Fig. 1A). Therefore, we deployed an endoscopic clip to move the lipoma away from the ampulla, which enabled us to achieve biliary cannulation (Fig. 1B). Selective biliary cannulation is a prerequisite to therapeutic ERCP. We show how the endoscopist should adopt different techniques using all endoscopic possibilities in the repertoire to achieve This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
960 GASTROINTESTINAL ENDOSCOPY Volume 82, No. 5 : 2015
biliary deep cannulation with reduced trauma to the ampulla. The endoscopist must be able to use this knowledge during different therapeutic endoscopic procedures to successfully perform ERCP in difficult cases. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Bruno Meduri, MD, Jean-Loup Dumont, MD, BertrandMarie Vergeau, MD, Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France, Fabrizio Cereatti, MD, Unit of Interventional Endoscopy, Department of General Surgery P. Stefanini, Sapienza University of Rome, Rome, Italy, Thierry Tuszynski, MD, Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France, Gianfranco Donatelli, MD, Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France, Unit of Interventional Endoscopy, Department of General Surgery P. Stefanini, Sapienza University of Rome, Rome, Italy http://dx.doi.org/10.1016/j.gie.2015.05.053
www.giejournal.org
Clip-assisted biliary cannulation to expose papilla covered by lipoma
Figure 1. A, Duodenal lipoma hiding papilla of Vater. B, Clip in place to retract lipoma and expose papilla of Vater.
Selective biliary duct cannulation during ERCP can be problematic in patients with anatomic alterations and may fail in up to 5% of cases. The most frequent factors leading to difficult cannulation are impacted stones, periampullary diverticula, and previous surgical procedures. Juxtapapillary lipoma is a rare condition that may challenge biliary cannulation. In Video 1 (available online at www.giejournal.org), we describe how to manage a juxtapapillary lipoma to achieve deep biliary cannulation. Here, the lipoma hindered the papillary orifice and interfered with selective cannulation (Fig. 1A). Therefore, we deployed an endoscopic clip to move the lipoma away from the ampulla, which enabled us to achieve biliary cannulation (Fig. 1B). Selective biliary cannulation is a prerequisite to therapeutic ERCP. We show how the endoscopist should adopt different techniques using all endoscopic possibilities in the repertoire to achieve This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
960 GASTROINTESTINAL ENDOSCOPY Volume 82, No. 5 : 2015
biliary deep cannulation with reduced trauma to the ampulla. The endoscopist must be able to use this knowledge during different therapeutic endoscopic procedures to successfully perform ERCP in difficult cases. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Bruno Meduri, MD, Jean-Loup Dumont, MD, BertrandMarie Vergeau, MD, Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France, Fabrizio Cereatti, MD, Unit of Interventional Endoscopy, Department of General Surgery P. Stefanini, Sapienza University of Rome, Rome, Italy, Thierry Tuszynski, MD, Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France, Gianfranco Donatelli, MD, Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, Paris, France, Unit of Interventional Endoscopy, Department of General Surgery P. Stefanini, Sapienza University of Rome, Rome, Italy http://dx.doi.org/10.1016/j.gie.2015.05.053
www.giejournal.org
