title: A novel second-generation multibending backward-oblique viewing duodenoscope in ERCP.
abstract: BACKGROUND
  Successful access to the papilla and cannulation of the desired duct can be technically challenging. A novel second-generation multi-bending backward-oblique viewing duodenoscope (2nd M-D scope) was developed to overcome this difficulty. The aim of the present study was to evaluate the utility of 2nd M-D scope during biliary ERCP.
  
  
  METHODS
  This was a retrospective review of 53 patients with native papilla who underwent biliary ERCP with the 2nd M-D scope.
  
  
  RESULTS
  Biliary cannulation and interventional procedures were successfully completed in all patients. In two of these patients, ERCP was initially attempted with a conventional single bending duodenoscope, but biliary cannulation was unsuccessful; one had Billroth-I gastrectomy, and the other had a Type III choledochal cyst. However, with the 2nd M-D scope, biliary cannulation and interventional procedures were successfully achieved. Finally, in nine patients, upward or downward angulation of the proximal bending portion in addition to the distal bending portion was used during ERCP, and the operator's comments demonstrated that it was helpful for obtaining an appropriate en face view to look up to the papilla and facilitate successful biliary cannulation.
  
  
  CONCLUSIONS
  The newly developed 2nd M-D scope could safely facilitate biliary cannulation in selected patients during ERCP.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine , Nishi-shinbashi, Minato-ku, Tokyo , Japan.
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Toyoizumi
authors.forename: Hiroo
authors.initials: H
authors.lastname: Imazu
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kanazawa
authors.forename: Masafumi
authors.initials: M
authors.lastname: Chiba
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D020698:Duodenoscopes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D012189:Retrospective Studies; D055815:Young Adult
keywords: Endoscopic retrograde cholangiopancreatography; biliary cannulation; en face view of the papilla; multi-bending backward-oblique viewing duodenoscope