title: Difficult Biliary Access: Advanced Cannulation and Sphincterotomy Technique.
abstract: Many devices and techniques have been developed to assist in cases of difficult biliary cannulation. Guidewire-assisted cannulation has become the first-line technique for biliary cannulation. Precut sphincterotomy can be safe and effective if used soon after encountering difficulty. Pancreatic duct stents are an important adjunct to reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult access. Ultimately, cannulation success of greater than 95% and complication rates of less than 5% is the standard that endoscopists doing ERCP should achieve.
authors.affiliation: Lenox Hill Hospital, 100 East 77th St., New York, NY 10075, USA.
authors.forename: Anish
authors.initials: A
authors.lastname: Mammen
authors.affiliation: Division of Gastroenterology, The Center for Advanced Therapeutic Endoscopy, Lenox Hill Hospital, 100 East 77th St., New York, NY 10075, USA. Electronic address: ghaber@nshs.edu.
authors.forename: Gregory
authors.initials: G
authors.lastname: Haber
mesh_terms: D001652:Bile Ducts / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D006801:Humans; D010183:Pancreatic Ducts / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods*
keywords: Advanced cannulation technique; Biliary cannulation; ERCP; Guidewire-assisted cannulation; Needle knife sphincterotomy; Precut sphincterotomy; Transpancreatic septotomy