A Novel Approach for Cannulation of the Ampulla within a Diverticulum: A Two-Catheter Method / 대한소화기내시경학회지

An ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Eventually a successful cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully.

Gallbladder Cancer Associated with an Anomalous Union of the Pancreaticobiliary Duct and a Choledochal Cyst / 대한소화기내시경학회지

An anomalous pancreaticobiliary ductal union is a rare anomaly occurring in the biliary tract. This anomaly has been implicated as a cause of choledochal cysts, bile duct and gallbladder carcinoma, and recurrent pancreatitis. A case is herein reported of a 63 year-old woman who suffered from gallbladder cancer associated with a choledochal cyst and an anomalous pancreaticobiliary union.