The Application of Clips during ERCP: A New Anchoring Method for Redundant Kerckrings Folds Covering the Duodenal Papilla / 대한소화기내시경학회지

ABSTRACT

During an endoscopic retrograde cholangiopancreatography (ERCP). cannulation is more difficult in patients with anatomical variations, papillary stenosis, an impacted stone in the papilla, papillary cancer, peripapillary diverticulum, postoperative states such as those after Billroth II or Braun operations, or redundant Kerckring's folds of the duodenum covering the duodenal papilla. For a patient suffering from a redundant Kerckrings folds of the duodenum and a common bile duct stone, a new technique applying clips to expose the duodenal papilla properly during ERCP was performed. After the application of the clips, the duodenal papilla was well exposed in a favorable position for proper cannulation. In this setting, an ERCP was easily performed with the standard cannula. After an endoscopic sphincterotomy (EST) with the pull-type papillotome was conducted, the common bile duct stone was successfully removed with a Dormia basket.