Post written by Allison Franz, MD, and David Liu, MD, from the Department of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.

We highlight cases in which tip palpation of the bile duct prior to needle-knife fistulotomy was effectively performed to achieve successful cannulation. To our knowledge, this case series is the first demonstration of this technique.  

Our video case series serves as an invaluable reference for endoscopists to learn this technique and start to implement it in their practice. Our hope is that this case series will help increase endoscopists’ confidence with and thus wider adoption of needle-knife fistulotomy.

Our case series aims to encourage endoscopists to start using tip palpation to identify anatomy/situations in which needle-knife fistulotomy can be used and offers guidance for implementing this technique to facilitate successful cannulation.

The red lines demarcate the outer borders of the bile duct. The green arrow illustrates the intraduodenal portion of the biliary duct. The green circle marks the ampulla.

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