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Cannulation in patients with large periampullary diverticulum using SpyBite miniforceps. Introduction: Cannulation is difficult in patients with periampullary diverticulum (PAD). The described success rate varies from 61% to 95.4%. Material and methods: Four cases with PAD in which, despite repeated attempts, we were unable to locate the papilla and cannulate. To overcome this difficulty, we used SpyBite forceps (Boston Scientific) to pull out the papillary orifice and then perform the cannulation using a sphincterotome introduced through the same working channel. Results: This method reduced the time required for cannulation. In all four of our cases, we had 100% success in cannulation. Conclusions: Use of SpyBite miniforceps in difficult cannulations in patients with PAD is useful and has an excellent success rate.