A 60 year-old man with obstructive jaundice due to an ulcerative papillary carcinoma underwent endoscopic retrograde cholangiopancreatography. Owing to the totally destroyed papilla of Vater, access to the biliary tract was impossible. Instead of needle knife fistulotomy, puncturing with an 18-G aspiration needle on the supra-papillary bulge followed by biliary stenting was performed successfully. To our knowledge, this technique has not been reported before in the English literature and probably can have fewer complications of bleeding and perforations produced by needle knife fistulotomy.
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