Successful endoscopic retrograde cholangiopancreatography using pancreatic guidewire placement for biliary cannulation in a patient with situs inversus and Billroth‐I gastrectomy (with video)
Yuki Tanisaka,
Shomei Ryozawa,
Kosuke Sudo,
Akashi Fujita,
Masafumi Mizuide,
Kouichi Nonaka,
Tomoaki Tashima
Affiliations
Yuki Tanisaka
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
Shomei Ryozawa
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
Kosuke Sudo
Department of Gastroenterology Southern Tohoku General Hospital Iwanuma, Miyagi Japan
Akashi Fujita
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
Masafumi Mizuide
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
Kouichi Nonaka
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
Tomoaki Tashima
Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
We reported a 95‐year‐old man with cholangitis who underwent Billroth‐I gastrectomy. He was diagnosed with situs inversus viscerum and ERCP was performed. A stable field of view could not be secured due to anatomical factors (Billroth‐I gastrectomy) and strong respiratory variations. However, pancreatic duct cannulation was possible. A pancreatic guidewire was placed to achieve selective biliary cannulation. This stabilized the field of view. The catheter was inserted on the right side of the guidewire. Cannulation to the 1 o'clock direction achieved biliary cannulation. Intended procedure was completed safely in the present case.
