ERCP cannulation of the major papilla hooded by a redundant Kerckring's fold: the technique of papillary traction and not hood elevation Eric Wee, MBBS,

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ERCP cannulation of the major papilla hooded by a redundant Kerckring's fold: the technique of papillary traction and not hood elevation Eric Wee, MBBS, MRCP, MMed Gastrointestinal Endoscopy Volume 77, Issue 3, Pages 515-516 (March 2013) DOI: 10.1016/j.gie.2012.11.004 Copyright © 2013 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A, Initial endoscopic view of the concealed major papilla beside a small duodenal diverticulum. B, Manipulation of the mucosa with the sphincterotome reveals only the frenulum. C, Major papilla revealed after the duodenal fold has been lifted. Gastrointestinal Endoscopy 2013 77, 515-516DOI: (10.1016/j.gie.2012.11.004) Copyright © 2013 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 A, Cannulation of the pancreatic duct with a sphincterotome while forceps are used to apply traction inferiorly. B, Biliary cannulation over the pancreatic stent with forceps maintaining traction to keep the papilla visible. C, Major papilla after biliary sphincterotomy. Gastrointestinal Endoscopy 2013 77, 515-516DOI: (10.1016/j.gie.2012.11.004) Copyright © 2013 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 A, Fluoroscopic image showing successful biliary guidewire cannulation over the pancreatic stent while the forceps is anchoring the papilla. B, Cholangiogram showing multiple large common bile duct stones. Gastrointestinal Endoscopy 2013 77, 515-516DOI: (10.1016/j.gie.2012.11.004) Copyright © 2013 American Society for Gastrointestinal Endoscopy Terms and Conditions