LAUSR

We describe a novel clip-with-line traction method to rescue a difficult pancreatic cannulation that failed with traditional techniques during endoscopic retrograde cholangiopancreatography (ERCP) in a patient with duodenal duplication (▶Video1). A 24-year-old woman suffered from repeated acute pancreatitis with no obvious reason, and was referred to our endoscopy center 1 day after a failed ERCP. The gastroscopy identified two intestinal lumens in the descending duodenum, indicating duodenal duplication (▶Fig. 1 a, c). The papilla was hidden in the ridge between the two lumens (▶Fig. 1b, d). Because it was very hard to target the ampullary orifice owing to frequent bowel movements and the specific angulation, pancreatic duct cannulation could not be achieved using various different traditional techniques, including wire-guided cannulation (▶Fig. 2 a), submucosal injection [1] (▶Fig. 2b), cannulation with a duodenoscope (▶Fig. 2 c), and remolding the sphincterotome (▶Fig. 2 d). Therefore, the clip-with-line traction method was introduced. A clip with a long dental floss attached was fixed near the papillary orifice at 9 o’clock (▶Fig.3 a) after several adjustments. As the papilla was lifted towards the tip of the sphincterotome, the sphincterotome was successfully advanced into the pancreatic duct, taking 2 minutes (▶Fig. 3b, c). After a small endoscopic