Guidewire cannulation in ERCP: from zero to hero!

For decades biliary cannulation during ERCP was done by lining up and advancing a catheter or a sphincterotome into the ampulla at what one believed was a "good" biliary angle and then gently (or not so gently) injecting contrast. This either resulted in a cholangiogram or a pancreatogram. If the bile duct was accessed, a wire was then advanced through the catheter into the biliary tree, and the procedure moved forward. If the pancreas was accessed, the catheter was pulled out and the maneuver was attempted again (and again and again) until ultimately successful or the biliary tree was not accessed.

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