title: Intramural incision technique.
abstract: BACKGROUND
  Therapeutic ERCP is technically complex. A variety of techniques can be used to achieve biliary access when direct cannulation is difficult. Pre-cut papillotomy can provide immediate access, but this technique is associated with an increased risk of complications.
  
  
  METHODS
  An intramural incision technique is described that uses the false tract created with a guidewire to place a papillotome though the intramural portion of the papilla and unroof the biliary orifice.
  
  
  METHODS
  Biliary access was achieved in 6 consecutive patients in whom access could not be obtained with either a papillotome or guidewire. No major complication occurred.
  
  
  CONCLUSIONS
  By virtue of the incision depth, the intramural incision technique offers a safer approach to biliary access than conventional pre-cut techniques. The technique is simple and will be useful when there is aberrant passage of a guidewire.
authors.affiliation: University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-8887, USA.
authors.forename: J Steven
authors.initials: JS
authors.lastname: Burdick
authors.forename: Alex
authors.initials: A
authors.lastname: London
authors.forename: Donald R
authors.initials: DR
authors.lastname: Thompson
mesh_terms: D001649:Bile Duct Diseases / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D006801:Humans; D016717:Sphincterotomy, Endoscopic / Q000379:methods*