Feasibility and Impact of Traction Band‐Assisted Cannulation for Difficult Biliary Cannulation in Patients With Periampullary Diverticulum: A Propensity Score‐Matched Analysis

ABSTRACT Background/Purpose Periampullary diverticulum (PAD) can make transpapillary biliary cannulation challenging. We aimed to evaluate the efficacy and safety of traction band‐assisted cannulation (TRIAS) using a novel clip‐band device for difficult biliary cannulation in patients with PAD. Methods This single‐center retrospective study included consecutive patients with PAD and difficult biliary cannulation who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2018 and March 2026. Patients were divided into conventional and TRIAS groups. One‐to‐two propensity score matching was performed using five pre‐ERCP variables. The primary outcome was the use of advanced cannulation techniques. Results A total of 133 patients were initially included, and 84 patients (56 in the conventional group and 28 in the TRIAS group) were included in the propensity score‐matched cohort. In the matched cohort, advanced cannulation techniques were required less frequently in the TRIAS group than in the conventional group (21.4% vs. 57.1%; odds ratio, 0.21; 95% confidence interval, 1.57–16.79; p = 0.002). Biliary cannulation success was similar between the TRIAS and conventional groups (89.3% vs. 85.7%; odds ratio, 1.38; 95% confidence interval, 0.11–3.36; p = 0.74). Conclusions The TRIAS method was associated with a reduced need for advanced cannulation techniques in patients with PAD and difficult biliary cannulation.