ERCP cannulation may come down to the wire

Ability to achieve duct access is a prerequisite since ERCP is now mostly performed with therapeutic intent. ERCP outcomes are linked to the success and safety of cannulation. Evaluation of an ERCP technique is complex because of integrally related factors including device properties, variable methods, patient characteristics, and endoscopist preferences and expertise. Remarkably, there has been little progress regarding primary cannulation techniques since the first contrast injection nearly 40 years ago. ERCP guidewires were initially designed and utilized in order to maintain ductal access during therapeutic maneuvers. Guidewires are now increasingly being used to achieve duct cannulation despite a paucity of data to support this practice. Are we heading in the right direction, or is wire-guided cannulation a misguided adventure?