A Selective Cannulation into the Common Bile Duct by a Guidewire Insertion through the Pancreatic Duct / 대한소화기내시경학회지

ABSTRACT

When the common bile duct (CBD) cannulation is attempted for the visualization and therapeutic intervention of biliary tree, difficulties can arise in the selective bile duct cannulation due to the deviation of the duodenal ampulla, a mobile ampulla or an acute angle between the CBD and the papillary orifice. During an attempt at a deep biliary cannulation for the endoscopic therapy, pancreatic sliding often occurs, which means a catheter or a sphincterotome inadvertently enter the pancreatic duct instead of the CBD. From our experience, we have learned that an acute angle between the CBD axis and ampullary orifice could cause pancreatic sliding. We could succeed in the deep cannulation of sphincterotome into the CBD after fixing the ampulla and blunting the acute angle of the CBD with a guidewire inserted into the pancreatic duct. No complications had occurred. This method may be a simple and useful tool in cases of recurrent pancreatic sliding and can avoid the post-ERCP pancreatitis subsequent to repeated cannulation of the pancreatic duct.