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Biliary cannulation in patients with periampullary diverticula is challenging due to high mobility and an unusual orientation of the papilla. Although papilla fixation using a pancreatic duct guidewire (PGW) has been performed in such cases, the procedure requires the placement of a guidewire in the pancreatic duct and takes times [1–4] (▶Fig. 1). The risk of PGW-induced postoperative pancreatitis has also been reported [5]. To overcome these challenges, we developed a novel method for difficult biliary cannulation without using a PGW, involving papilla fixation with a unique double-lumen catheter A 68-year-old woman presented with obstructive jaundice due to pancreatic cancer. Biliary drainage was attempted. However, biliary cannulation was difficult because the papilla was highly mobile with many periampullary diverticula and the orientation of the papilla was unusual. The contrasted pancreatic duct was E-Videos

A novel method of papilla fixation for difficult biliary cannulation without using a pancreatic duct guidewire: non-guidewire fixation method