Technical overview of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography: A guide for the endoscopist

Figure 1 Double guidewire technique for difficult biliary cannulation. A and B: Inadvertent pancreatic duct (PD) cannulation during conventional endoscopic retrograde cholangiopancreatography (guidewire entering PD) (A) on endoscopic image and on fluoroscopic image (B); C and D: With the guidewire in place in PD, sphincterotome used to selectively cannulate the bile duct (double guidewire technique) (C), this was which was confirmed on fluoroscopic image (D); E and F: Once bile duct cannulation is confirmed, deep cannulation was achieved and was successful (E), as confirmed on fluoroscopic image (F).