Forceps-Assisted Endoscope Rigidity Reinforcement for Difficult Duodenal Intubation due to Cascade Stomach

TL;DR

A new technique using forceps to help with difficult endoscope insertion in the duodenum is shown to be effective in elderly patients.

Contribution

A novel, equipment-free method using forceps to reinforce endoscope rigidity during ERCP is introduced and validated.

Findings

Forceps inserted through the accessory channel increased endoscope rigidity and enabled successful duodenal intubation.

The technique minimized scope looping and allowed rapid access to the duodenum within 2 minutes.

The method was successfully applied in two ERCP procedures, enabling biliary cannulation and drainage.

Abstract

A 92-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholecystitis and bile duct stones. A cascade stomach caused significant difficulty in duodenal intubation, despite multiple standard maneuvers. As a large-diameter overtube was unavailable, forceps were inserted through the accessory channel to increase endoscope rigidity. This technique minimized scope looping and enabled duodenal access within 2 minutes. Biliary cannulation, sphincterotomy, and drainage were completed successfully. The same method was used in a subsequent ERCP with similar success. This case demonstrates that forceps-assisted rigidity reinforcement is a simple, effective, and equipment-free option for managing duodenal intubation difficulties during ERCP.

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