title: Pancreatic-duct stent placement facilitates difficult common bile duct cannulation.
abstract: BACKGROUND
  Cannulation of the common bile duct can be difficult in certain instances. Difficult cannulation has been demonstrated to be a risk factor for post-ERCP pancreatitis. We report a technique to facilitate difficult cannulation that uses a pancreatic-duct stent to guide biliary cannulation.
  
  
  METHODS
  A retrospective review of all ERCPs performed at our institution from October 1, 2000 to June 30, 2004 (1638) was performed to identify all cases in which a pancreatic-duct stent was placed to guide common bile duct cannulation. Charts on these patients then were reviewed to assess cannulation success and complications. In addition, indications for the ERCP and previously failed cannulation attempts by outside physicians were documented.
  
  
  METHODS
  Thirty-nine patients had pancreatic-duct stents placed as an aid to guide common bile duct cannulation. Successful cannulation of the bile duct was achieved in 38 of the 39 patients (97.4%) Procedure-related pancreatitis occurred in two patients and was mild in both. There were no procedure-related deaths.
  
  
  CONCLUSIONS
  In cases of difficult common bile duct cannulation, placement of a pancreatic-duct stent as a guide to aid common bile duct cannulation appears to be an effective and safe technique.
authors.affiliation: Division of Gastroenterology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Goldberg
authors.forename: Mark
authors.initials: M
authors.lastname: Titus
authors.forename: Oleh
authors.initials: O
authors.lastname: Haluszka
authors.forename: Peter
authors.initials: P
authors.lastname: Darwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D001651:Cholestasis, Extrahepatic / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome