Efficacy of splinting tube-assisted duodenoscope insertion in patients with an inaccessible major papilla: a single-center retrospective study (with video).

[BACKGROUND AND AIMS] ERCP is a crucial diagnostic and therapeutic tool for pancreatobiliary diseases. However, it carries risks of serious adverse events (AEs), including pancreatitis and perforation. Recently, the use of a splinting tube to facilitate duodenoscope insertion has been reported in cases of difficult access. This study evaluated the efficacy and safety of splinting tube-assisted duodenoscope insertion during ERCP.

[METHODS] We retrospectively reviewed patients who underwent ERCP with splinting tube assistance between March 2024 and March 2025 at the Tokyo Medical University Hospital. The primary outcomes were technical and clinical success rates, and the secondary outcomes included procedure time and AEs.

[RESULTS] Eight patients (median age, 71 years; range, 54-91) were included in this study. The indications for ERCP included benign biliary stricture (n = 2), common bile duct stones (n = 2), malignant biliary stricture due to pancreatic cancer (n = 2), intrahepatic stones (n = 1), and bile leak after cholecystectomy (n = 1). The difficulty in insertion was caused by gastric deflection without prior surgery (n = 5), duodenal ulcer-related deformation (n = 2), or gastric deflection after left hepatic lobectomy (n = 1). Technical success was achieved in all cases (100%), and clinical success was achieved in 7 (87.5%). The median procedure time was 44.5 minutes (range, 30-82 minutes). No procedure-related or delayed AEs were observed.

[CONCLUSIONS] Splinting tube-assisted duodenoscope insertion is a safe and effective troubleshooting technique for difficult insertion into the descending limb of the duodenum.