Biliary cannulation during endoscopic retrograde cholangiopancreatography: core technique and recent innovations

Despite advances in imaging and device technology over the past decade, endoscopic retrograde cholangiopancreatography (ERCP) continues to be one of the most technically challenging interventions in endoscopy. The procedure remains compounded by two persistent problems: failure of successful biliary cannulation and post-ERCP pancreatitis (PEP). When performed outside expert high-volume centers, failed biliary cannulation may occur in up to 20% of cases; repeated and prolonged attempts at cannulation increase the risk of pancreatitis, delay definitive therapy, and necessitate alternative therapeutic techniques with inferior safety profiles [1,2]. Cannulation technique is believed to be a pivotal factor in the genesis of PEP and is obviously important for successful cannulation. This review will discuss some recent innovations in cannulation technique.