Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation

Figure 1 Techniques for difficult cannulation. A: Two-devices in one-channel method; B: Double endoscope method; C: Balloon dilation of the narrow diverticular neck; D: Endoclip-assisted cannulation; E: Cap-assisted cannulation; F: Pancreatic duct stent placement followed by pre-cut biliary sphincterotomy; G: Percutaneous ultrasound-guided rendezvous technique; H: Endoscopic ultrasound-guided rendezvous technique.

Figure 2 Proposed algorithm to ensure the best outcome. EUS: Endoscopic ultrasound.