Review
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World J Gastrointest Endosc. Mar 16, 2010; 2(3): 97-103
Published online Mar 16, 2010. doi: 10.4253/wjge.v2.i3.97
Management of difficult bile duct cannulation in ERCP
Marianne Udd, Leena Kylänpää, Jorma Halttunen
Marianne Udd, Leena Kylänpää, Jorma Halttunen, Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, POB 340, HUS 00029, Helsinki, Finland
Author contributions: Udd M, Kylänpää L and Halttunen J have reviewed the literature, written the text and revised it.
Correspondence to: Jorma Halttunen, MD, PhD, University of Helsinki, Meilahti Hospital, Department of Gastrointestinal and General Surgery, Haartmaninkatu 4, POB 340, HUS 00029, Finland. jorma.halttunen@hus.fi
Telephone: +358-5-04270635 Fax: +358-9-47174688
Received: July 23, 2009
Revised: January 29, 2010
Accepted: February 5, 2010
Published online: March 16, 2010
Abstract

In Encoscopic Retrograde Cholangiopancreatography (ERCP), the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis. Difficult cannulation is defined as a situation where the endoscopist, using his/her regularly used cannulation technique, fails within a certain time limit or after a certain number of unsuccessful attempts. Different methods have been developed to manage difficult cannulation. The most common solution is to perform a precut papillotomy either with a needle knife or with a sphincterotome with or without a guide wire. This review describes different methods to overcome cases of difficult cannulation. We will discuss the success rate and complication rates associated with different methods of reaching the biliary tract.

Keywords: Endoscopic retrograde cholangiopancreatography, Difficult cannulation, Sphincterotomy, Precut, Complication