Abstract
Biliary cannulation is indispensable for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary diseases. As difficulties in selective biliary cannulation during ERCP are sometimes encountered due to anatomical constraints or papillary spasm, numerous techniques have been developed to overcome such difficulties. Wire-guided cannulation may improve the success rate of biliary cannulation and reduce the frequency of post-ERCP pancreatitis. Pancreatic guidewire placement or the double guidewire technique have been reported to be useful for achieving biliary cannulation in cases of difficult biliary cannulation. If selective biliary cannulation is unsuccessful even with these techniques, precut followed by placement of a pancreatic duct stent by an experienced endoscopist is recommended.
