ABSTRACT
During endoscopic retrograde cholangiopancreatography (ERCP), cannulation is more difficult in patients with anatomical variations, ampullary stenosis, impacted stone in the papilla, papillary cancer, peripapillary diverticulum, postoperative states such as those after Billroth II or Braun operations. In patients with peripapillary diverticulum, the position of the papilla can be modified by the presence of the diverticulum, rendering the cannu-lation more difficult. In this situation, the success rate of ERCP is lower than that in nor-mal situation. We have, therefore, used a new technique with the application of grasp forceps to expose the duodenal papilla properly during ERCP in a patient whose papilla was located on the edge of a large duodenal diverticulum and the papillary orifice was hidden behind the edge of the diverticulum.