Long-scope position insertion for a challenging bile duct access by a novel digital single-operator cholangioscope (SpyGlass DS) in periampullary diverticulum.

Single-operator cholangioscopy (SOC) is a valuable diagnostic (e.g. stricture) and therapeutic (e.g. lithotripsy) platform for treatment of complex biliary diseases. Technical success rates, i.e. advancement up to a pre-defined target lesion, are generally high. Anatomic factors, such as periampullary diverticula, however, may complicate scope insertion, for which a novel troubleshooter technique, designated the "long scope position insertion", is presented here.