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ERCP using a special catheter with external steering. A reliable aid in typical ERCP problems.

ERCP is the most sensitive procedure for opacification of the bile and pancreatic ducts. The procedure fails, however, in up to 60% of Billroth II resected patients, and in 5% of nongastrectomized patients, often owing to problems of papillary cannulation with the conventional ERC-catheter, or insufficient control in the bile duct. Therefore, we attempted to perform ERCP with a catheter provided with external steering, which can be introduced through the channel of any commercially available endoscope. This catheter permitted successful ERCP in 11 patients in whom conventional ERCP technique had failed. The endoscopic procedure with the catheter described was simple and reduced papillary cannulation problems in patients with juxtapapillary diverticulum and in those with Billroth II resection, and it permitted selective opacification of intrahepatic bile ducts or the cystic duct.