The Art of Selective Cannulation at ERCP

Area of Science:

• Gastroenterology
• Endoscopy
• Interventional Endoscopy

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is celebrating its 50th anniversary.
• The procedure has transitioned from primarily diagnostic to a predominantly therapeutic role.
• Advancements in technology and technique have been crucial to this evolution.

Purpose of the Study:

• To reflect on 42 years of experience in accessing biliary and pancreatic ducts via ERCP.
• To illustrate the evolution of techniques for primary duct cannulation.
• To review available cannulation devices and approaches.

Main Methods:

• Review of techniques and devices used over 42 years of ERCP practice.
• Personal experience and team approach in biliary and pancreatic duct cannulation.
• Discussion of various cannulation catheters and guidewires.

Main Results:

• Significant evolution in ERCP from diagnostic to therapeutic applications.
• Development of diverse devices and techniques for accessing biliary and pancreatic ducts.
• Cannulation success rates have improved with evolving methods.

Conclusions:

• ERCP's shift to a therapeutic role necessitates advanced cannulation techniques.
• Operator preference and team approach influence device and wire selection.
• Further prospective studies are needed to compare the efficacy of different devices and wires.