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We reported a 95‐year‐old man with cholangitis who underwent Billroth‐I gastrectomy. He was diagnosed with situs inversus viscerum and ERCP was performed. A stable field of view could not be secured due to anatomical factors (Billroth‐I gastrectomy) and strong respiratory variations. However, pancreatic duct cannulation was possible. A pancreatic guidewire was placed to achieve selective biliary cannulation. This stabilized the field of view. The catheter was inserted on the right side of the guidewire. Cannulation to the 1 o'clock direction achieved biliary cannulation. Intended procedure was completed safely in the present case.

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Successful endoscopic retrograde cholangiopancreatography using pancreatic guidewire placement for biliary cannulation in a patient with situs inversus and Billroth‐I gastrectomy (with video)