WIRE GUIDED CANNULATION: CLINICAL PERSPECTIVE A Review of the Literature and Appraisal of the Technique

Cannulation is the passage of a guidewire, catheter, or other device through a duodenoscope into the bile duct or pancreatic duct at Endoscopic Retrograde Cholangiography and Pancreatography (ERCP). It is the initial step in all diagnostic and therapeutic ERCP and is a major hurdle for many individuals performing this procedure. Failed cannulation is also the most common cause for failure to achieve the desired clinical outcome in patients undergoing ERCP. Cannulation techniques vary widely. There is no work that defines the optimum cannulation technique. The process of cannulation has a number of variables that will determine success including operator expertise, device selection, and patient anatomy. Additionally, it has been suggested and demonstrated in prospective trials that factors occurring at cannulation can lead to significant post ERCP pancreatitis. Over the past decade, wire guided cannulation has been advocated by some as a way to improve cannulation rates and limit complications of cannulation. It has been employed in a variety of techniques with a number of different devices. Recent advances with systems that allow physician control of the guidewire and new guidewire technologies have led to increased interest in wire guided cannulation. In the past, guidewires were stiff, without significant hydrophilic coatings, and usually manipulated by assistants. There was concern that forceful probing with these guidewires could cause ampullary trauma or pancreatic duct damage.