Techniques for difficult endoscopic biliary cannulation cases

Abstract

ERCP and associated procedures are widely used for the management of biliary disorders. Successful biliary cannulation is the initial mandatory step for all subsequent procedures. Achieving deep biliary cannulation can be challenging at times for experts and novices alike. The techniques available for cannulation have expanded. Several alternative techniques have been attempted after failed initial biliary cannulation using the routine techniques. Pancreatic guidewire technique may be most popular as a first salvage technique, followed by several precut techniques. Moreover, use of EUS guided rendezvous technique has also been recently increasing. It is necessary to become familiar with a variety of the newer techniques already available. We should not repeat the same approach and try to use alternative techniques which are tailored to the individual papillary and ductal anatomy of each patient.