Looping technique for transpapillary selective biopsy of the left hepatic duct

Purpose. Because biopsy forceps fend to turn towards the right hepatic duct during endoscopic retrograde cholangiopancreatography (ERCP), selective ac cess to the left hepatic duct is difficult. Methods. In this study, we mana ged to insert biopsy forceps selectively into the left hepatic duct, by usi ng a looping technique, in three patients. Biopsy forceps were inserted int o the right hepatic duct by the conventional method. The elevator of the en doscope was kept down, and the shaft of the biopsy forceps was then advance d to the duodenal cavity until it formed a loop between the endoscope and t he papilla. During the procedure, the tip of the forceps was kept at: the h epatic hilus. Results. In this condition, we were able to slowly rotate the tip of the forceps and direct the forceps towards the left. Sufficient mat erial from the left hepatic duct was obtained in all patients. Conclusions. The looping technique was useful for selective access to the left hepatic duct.