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Difficult Biliary Cannulation - Tips and Tricks

Difficult Biliary Cannulation - Tips and Tricks

19 Aug 2021 12:20 12:40
(20 mins)
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Successful biliary cannulation is the prerequisite for subsequent endoscopic biliary therapy during endoscopic retrograde cholangiopancreatography (ERCP). Difficult cannulation is encountered in approximately 11% of therapeutic ERCPs and increases the risk of post-ERCP adverse events, particularly post-ERCP pancreatitis (PEP). Therefore, measures for prophylaxis of PEP should be implemented when difficult cannulation is encountered, including per rectal non-steroidal anti-inflammatory drugs (NSAIDs), pancreatic duct stent, and hydration. Various methods can be utilized to overcome difficult biliary cannulation, including pancreatic guidewire-assisted technique, pancreatic duct stent-assisted cannulation, precut, and transpancreatic biliary sphincterotomy. These techniques/procedures are more complex and may carry increased risk of complications. Repeat ERCP at another session, rendezvous technique, or EUS-guided biliary access can be considered when the above advanced techniques still fail to provide access to the bile duct.

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