A comprehensive review of biliary cannulation techniques in endoscopic retrograde cholangiopancreatography

Abstract

Introduction: Successful biliary cannulation is crucial for the efficacy of endoscopic retrograde cholangiopancreatography (ERCP). Failure to achieve cannulation can lead to procedure failure, highlighting the importance of mastering various cannulation techniques, particularly in challenging cases.

Areas covered: This article examines advanced biliary cannulation techniques, including guidewire-assisted methods, precut sphincterotomy, and rendezvous procedures. The literature search encompassed PubMed/MEDLINE, Embase, and the Cochrane Library from inception to April 2024, focusing on randomized trials, meta-analyses, and systematic reviews evaluating efficacy and safety.

Expert opinion: This paper advocates for a structured, algorithmic approach to cannulation, emphasizing early recognition of difficulty and strategic escalation to advanced techniques to enhance success rates and minimize complications like post-ERCP pancreatitis.

Keywords: Biliary cannulation; ERCP; EUS-guided rendezvous; Post-ERCP pancreatitis; double-wire technique; guidewire-assisted cannulation; pancreatic duct stent; precut sphincterotomy.