Clip-Assisted Traction Technique for Cannulation of a Peri-Diverticular Papilla During Endoscopic Retrograde Cholangiopancreatography: A Case Report

During endoscopic retrograde cholangiopancreatography (ERCP), successful tube placement is the first step. Common clinical challenges include difficult cannulation, elderly patients, and peri-diverticular papilla. The objective of this study is to facilitate papillary exposure using clip traction. This research applied the endoscopic hemostasis clip to pull the mucosa technique, providing a safer and more effective solution for difficult intubation in the elderly by adjusting the papillary spatial orientation. This technique breaks through the traditional hemostatic function of hemostasis clips and uses them as mechanical traction tools. By clamping and adjusting the traction direction of the papillary mucosa, it can realign the papilla close to the diverticulum or the papilla with the intubation path along an axis. It provides a standardized method for difficult ERCP in elderly patients, with significant social benefits and promotional significance. A 67-year-old male patient with choledocholithiasis presented with a major duodenal papilla located within a diverticulum. During ERCP, we successfully cannulated and completely removed the common bile duct stones using a hemostatic clamp-assisted traction technique. Hemostatic clamp-assisted traction facilitates cannulation in patients with difficult cannulation during ERCP, particularly those with duodenal papillary diverticula. Its efficacy requires verification in future large-scale studies.