Euroasian Journal of Hepato-Gastroenterology

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VOLUME 11 , ISSUE 2 ( July-December, 2021 ) > List of Articles

CASE REPORT

“Lever Technique”: A Novel Approach to Cope with Unstable Scope Position during Bottom-up Needle Knife Access (with Video)

Vincent Zimmer

Keywords : Biliary access, Biliary pancreatitis, Choledocholithiasis, Endoscopic ultrasound, Gall stone disease, Needle knife papillotomy, Scopic retrograde cholangiopancreatography

Citation Information : Zimmer V. “Lever Technique”: A Novel Approach to Cope with Unstable Scope Position during Bottom-up Needle Knife Access (with Video). Euroasian J Hepatogastroenterol 2021; 11 (2):95-96.

DOI: 10.5005/jp-journals-10018-1349

License: CC BY-NC 4.0

Published Online: 22-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Needle knife papillotomy has become an invaluable advanced biliary access technique in routine endoscopic retrograde cholangiopancreatography (ERCP). Albeit poorly standardized in terms of procedural details, usually superficial cuts are applied to open the bile duct in an onion-like manner. However, this implies the capability to direct cuts from some distance from the papilla controlling needle knife movements in a complex fashion involving elevator movements. Here, an as-yet unreported technique designated the “lever technique” is presented for difficult needle knife access, when encountering technical difficulties, such as unstable scope position and awkward bile duct angle to allow for controlled needle knife navigation. In such variant rescue approach involving well-characterized prepapillary stone impaction by preceding same-session endoscopic ultrasound (EUS), thus providing some safety plane, ultranear-view instrumentation is coupled with exclusive needle knife navigation by moving the large dial, thus moving scope and needle knife-like as one endoscopic device.


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