ERCP Bootcamp: Cutting Edge Comprehensive Training for the Team | July 2026-Biliary Cannulation Techniques

Video Transcription

Video Summary

The speaker, an experienced ERCP endoscopist, presents a practical overview of biliary cannulation from basic to advanced methods. He emphasizes first recognizing different papilla types and adapting technique to anatomy: normal, pinpoint, redundant, bulging, and deeply located papillae each require different approaches. Key basics include staying calm, cleaning the field, orienting the scope properly, and using freehand cannulation when helpful.<br /><br />He explains wire-guided cannulation, including how guidewire shape, cannula choice, and papilla lifting affect success. He also discusses difficult scenarios such as separate biliary and pancreatic orifices, diverticular papillae, and bleeding-prone patients.<br /><br />Advanced rescue strategies include the double-wire technique, pancreatic duct stenting to facilitate biliary access, needle-knife access, fistulotomy, trans-pancreatic septotomy, and EUS-guided rendezvous or direct puncture. He compares advantages and risks, especially the risk of pancreatitis and later stenosis, and stresses that technique choice should depend on patient anatomy, clinical context, and operator experience.<br /><br />A major theme is flexibility: if one approach fails, change the wire, cannula, orientation, or technique rather than forcing it. The discussion also highlights the importance of informed consent, caution with advanced methods, and tailoring aggressiveness to the patient’s condition.

Asset Subtitle

Simon K. Lo, MD, FASGE

Keywords

ERCP

biliary cannulation

papilla anatomy

wire-guided cannulation

needle-knife access

pancreatic duct stenting

EUS-guided rendezvous