Difficult cannulation: what should I do before EUS guided access?

Selective cannulation of the common bile duct can be difficult, so multiple strategies have been developed to overcome the situation. In this review we analize the different strategies that can be used like different papillotome instead of the standard catheter, precut papillotomy using precut needle knives or precut papillotome, transpancreatic papillary septotomy, and stenting of the pancreatic duct. Bile duct cannulation remains an important benchmark of successful ERCP. Alternative biliary access indication and its use is very important If biliary cannulation remains unsuccessful.The suprapapillary puncture is a promissory technique. It's important to have in mind that the goal of all techniques is to provide acute pancreatitis decrease.

Difficult cannulation: what should I do before EUS guided access? / Canulación difícil: ¿qué hacer antes de acceso guiado por EUS?

Selective cannulation of the common bile duct can be difficult, so multiple strategies have been developed to overcome the situation. In this review we analize the different strategies that can be used like different papillotome instead of the standard catheter, precut papillotomy using precut needle knives or precut papillotome, transpancreatic papillary septotomy, and stenting of the pancreatic duct. Bile duct cannulation remains an important benchmark of successful ERCP. Alternative biliary access indication and its use is very important If biliary cannulation remains unsuccessful.The suprapapillary puncture is a promissory technique. It´s important to have in mind that the goal of all techniques is to provide acute pancreatitis decrease.

La canulación selectiva del conducto biliar común puede ser difícil por eso se han desarrollado diferentes estrategias para disminuir esta dificultad. La presente revisión analiza el uso de papilótomos diferentes en lugar del catéter estándar, la papilotomía con pre corte usando cuchillos o papilótomos, la septotomía papilar transpancreática y el uso de stents. La canulación biliar sigue siendo el factor más importante para considerar una ERCP como exitosa. Las indicaciones de accesos biliares alternativos y su uso es muy importante si esta falla. La punción suprapapilar es una técnica promisoria. Es importante tener en cuenta que la meta de todas las técnicas es disminuir la ocurrencia de pancreatitis aguda.