ERCP USING A FOREWARD-VIEWING FIBER SCOPE

Our first experience with newly designed pediatric forward-viewing fiberscope G1F-P2 (Olympus Co.) showed that this instrument can easily pass the first and second portion of the duodenum and the papilla of Vater is visible tangentially in all cases. In our first trials we were able to manage the tip of the instrument in a position ready for cannulation. A new technique of ERCP using this instrument is described in detail. By this procedure the position of the maximal tended tip of the instrument provides a more selective cannulation into the common bile duct, preventing the risk of pancreatic duct filling. The method was performed to 15 cases. FRCP, using this technique, can be performed after normal esophago-gasro-duodenoscopy. Therefore, we wanted to test if this instrument can be used for ERCP and when possible, if a combined method of upper GI endoscope and visualization of the duct system will probably become the routine procedure. This method was performed to 15 cases and succeeded in 12. The bile duct was filled in 12 cases and the pancreatic duct in 4. Further experiences are nessssary to estimate the value of the new method. At present time, we only can maintain that cannulation of the papilla of Vater is possible and compared to normal ERCP using side-viewing fiberscope the visualizaition rate of the biliary system is higher than of the pancreatic duct. But present stage of experiences usual ERCP by duodenofiberscope is easier to perform and may be the first procedure of filling the duct systems. The new technique may be recommended when using a duodenofiberscope the visualization of the biliary system is missed or when combination of upper GI endoscope, based on the anatomic condition, intubation of the papilla is easy in a short time. From our experiences, the new method of ERCP is not a routine procedure. It is reserved for special indications. Acknowledgement The author is indebted to Prof. E. Seifert (West Germany) for his kind cooperation and generous supply of materials.