Impact of changing our cannulation method on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis after pancreatic guidewire placement

Figure 1 Our strategy for difficult biliary cannulation. PGW: Pancreatic guidewire placement; ERCP: Endoscopic retrograde cholangiopancreatography; PTBD: Percutaneous transhepatic biliary drainage; EUS-BD: Endoscopic ultrasound-guided biliary drainage.

Figure 2 Fluoroscopic image taken during pancreatic guidewire placement using a single-lumen catheter. A: The injection of contrast medium into the pancreatic duct was repeated for difficult biliary cannulation; B: During pancreatic guidewire placement (PGW), the guidewire pushes contrast medium from the catheter lumen and into the pancreatic ductal system; C: PGW straightens the terminal bile duct and achieves successful biliary cannulation.