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


CONCLUSIONS
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.
Draganov
Peter
P
University of Florida, PO Box 100214, Gainesville, FL 32610-0214, USA. dragapv@medicine.ufl.edu
Devonshire
David A
DA
Cunningham
John T
JT
D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003135:Common Bile Duct / Q000601:surgery*; D006801:Humans; D010183:Pancreatic Ducts / Q000601:surgery