An alternative approach to the inaccessible intradiverticular papilla

Background: In patients with a narrow-necked juxtapapillary diverticulum th e endoscopic cannulation of the papilla of Vater and the subsequent biliary therapy is sometimes impossible. Patients and Methods: Three patients referred for endoscopic retrograde cho langiography and stone extraction were included. Earlier attempts to cannul ate failed because visual control was impeded by narrow-necked juxtapapilla ry diverticula with the papilla located in the fundus. Endoscopic baboon di lation of the narrow diverticular neck, using a 15-mm stone retrieval ballo on, tvas carried out. Results: In all three cases the papillary orifice was readily brought into view after balloon dilation of the diverticular opening. Subsequent endosco pic treatment to the bile duct was successful without any complications. Conclusion: Balloon dilation of a narrow-necked juxtapapillary diverticulum is a safe and easy procedure, which facilitates both cannulation of the pa pilla and subsequent biliary endoscopic treatment.