Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website http://www.journalmc.org

Case Report

Volume 10, Number 1, January 2019, pages 1-3

A Double-Guidewire Technique to Facilitate Deep Cannulation and Stenting in a Patient With Altered Gastrointestinal Anatomy

Figures

Figure 1.
Figure 1. (a) Computed tomography revealed a low-density mass with dilatation of the biliary tract. (b) ERCP showed a bending, meandering dilatation and a lower stricture of the common bile duct.
Figure 2.
Figure 2. (a) A guidewire (VisiGlide 2; Olympus Co., Ltd, Tokyo, Japan) was inserted into the intrahepatic bile duct. (b) A catheter (MTW; MTW Endoskopie, Wesel, Germany) was not passed due to severe stricture of the lower common bile duct and axis-dismatch between the bile duct and the catheter.
Figure 3.
Figure 3. (a, b) Another of the same guidewire was inserted into the bile duct. (c) The catheter was easily passed into the bile duct. (d) A 7-Fr plastic stent (Zimmon Biliary Stent; Cook Medical) was successfully inserted.