Abstract
Selective deep biliary cannulation is a basis for therapeutic ERCP. Conventional contrast-assisted biliary cannulation is widely used in Japan. Wire-guided cannulation (WGC) technique is a new method and reported to increase the cannulation rate and decrease post-ERCP pancreatitis in some prospective studies. The method of WGC is as follows : a hydrophilic-tipped guidewire is preloaded into a sphincterotome, the sphincterotome is bowed to align correctly with the axis of the bile duct on the papilla, then the guidewire is carefully advanced into the common bile duct under fluoroscopy after a minimal insertion of the sphincterotome in the papilla, followed by insertion of the sphincterotome and contrast injection to verify deep bile duct cannulation.
WGC is reported to reduce post-ERCP pancreatitis by avoiding mechanical damage of the papilla and the contrast injection in the pancreatic duct. The disadvantages of WGC are the cost of a sphincterotome and the risk of complications such as mechanical damage to the papilla or perforation of bile duct by a guidewire due to inexperience in the guidewire manipulations. WGC is one of the useful biliary cannulation methods, but skillfulness in both WGC and conventional contrast-assisted cannulation is necessary for the expert endoscopists. Further randomized controlled studies are needed to confirm the utility of WGC in Japan.
