A new technique to assist in difficult bile duct cannulation at the time of endoscopic retrograde cholangiopancreatography.

Peter Draganov, David A. Devonshire, John T. Cunningham

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


BACKGROUND AND OBJECTIVES: At the time of endoscopic retrograde cholangiopancreatography, deep cannulation of the bile duct is a prerequisite to be able to provide endoscopic therapy. We describe a simple technique to assist in difficult bile duct cannulation. METHODS: If the pancreatic duct is easily entered but the bile duct cannot be accessed, a guidewire is advanced into the pancreatic duct, and the cannulating catheter is removed leaving the tip of the wire in the mid pancreatic duct. Alongside the pancreatic wire, a catheter, preloaded with a second wire, is advanced via the channel of the endoscope. With the first wire in the pancreatic duct, the second wire is advanced above it in the anticipated bile duct axis. RESULTS: We have used this technique in 12 cases and succeeded in 10. No complications occurred. DISCUSSION: Inserting a pancreatic wire can assist in bile duct cannulation, by straightening and stabilizing the papilla. The use of this new technique can reduce the need for precut sphincterotomy, with its inherent increased risks of pancreatitis, bleeding, and perforation. The approach proposed by us can assist in any difficult bile duct cannulation, but it can be particularly useful when dealing with a papilla that is very prominent with a tortuous intraduodenal segment or a papilla located in a duodenal diverticulum.

Original languageEnglish (US)
Pages (from-to)218-221
Number of pages4
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Issue number2
StatePublished - 2005
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


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