SpyBite-Assisted Biliary Cannulation Facilitating Endoscopic Retrograde Cholangiopancreatography in the Presence of Intradiverticular Papilla.

Biliary cannulation in the context of intradiverticular papilla (IDP) during endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge even for experts. A 71-year-old woman with choledocholithiasis failed extrainstitutional ERCP because of the presence of IDP. A new ERCP was performed, identifying papillary orifice at the edge of the diverticulum, biliary cannulation by means of SpyBite and sphincterotome, visualizing intra and extrahepatic bile duct dilatation, proceeding to large balloon bilioplasty with extraction of biliary sludge, with optimal results and without complications. This strategy was effective and safe. It could be recommended for difficult cannulation in the presence of IDP.