2019 Volume 33 Issue 1 Pages 69-75
Selective bile duct cannulation is one of the most important technique for all endoscopic biliary therapeutic interventions. In endoscopic retrograde cholangiopancreatography (ERCP), selective bile duct cannulation by the standard technique has been reported to fail even in experienced hands. First of all, training for biliary cannulation must be performed in safety. Trainees should perform as an assistant under the guidance of experts at first, and should be recommended to experience the training using simulators. Before confronting real patients, we should confirm the strategy for bile duct cannulation. When unintentional pancreatic approach is repeated, there are two ways to assist bile duct cannulation with pancreatic guidewire placement. One is the pancreatic guidewire technique, and the other is transpancreatic pre-cut papillotomy. Both of which can be followed by prophylactic pancreatic stents insertion to avoid post-ERCP pancreatitis. If both bile duct approach and pancreatic duct approach cannot be achieved, needle knife precutting can be selected. Instructors have to confirm how they manage to teach trainees in adequate manners, and have to be familiar with various techniques without sticking to only one technique.
