Editorial: Guidewire Trauma: A Key Component of Post-ERCP Pancreatitis That Is Best Controlled by the Endoscopist

Recent studies have revealed that deep pancreatic duct wire passage, even in the absence of contrast injection, is a major technique-related culprit in post-ERCP pancreatitis, unless followed by placement of a pancreatic stent. As guidewire cannulation becomes increasingly widespread, precise control of the guidewire is thus critical. The first randomized trial to compare endoscopist-controlled wire guided vs. assistant-controlled bile duct cannulation has shown a significant reduction in post ERCP pancreatitis when the physician manipulates the wire. Though there is no single universal solution to post-ERCP pancreatitis, careful attention to wire contol is emerging as an important aspect of safety in ERCP.