Management of difficult bile duct cannulation in ERCP

Table 1 Tools and methods for cannulation

Standard techniques

Catheters:

Standard

Steerable

With or without guide wire

Sphincterotomes:

Single or multi-lumen

Rotatable

With or without guide wire

Guidewires:

Nitinol

Hydrophilic

Advanced techniques without precut

Double wire technique

Over pancreatic stent

Precut access with

Needle knife:

Starting at orifice

Fistulotomy above orifice

Over pancreatic stent

Sphincterotome:

Erlangen sphincterotome

Transpancreatic with guide wire

Papillectomy for duct access

EndoUS-guided biliary access