Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation

Figure 1 Radiologic images showing the use of double-guidewire technique and transpancreatic precut sphincterotomy. A: Guidewire inserted and left in the pancreatic duct (PD) [double-guidewire technique (DGT)]; B: Common bile duct cannulation with a guidewire after previous insertion of a guidewire in the PD (DGT); C: Sphincterotomy performed with a cutting wire along the biliary direction at 11 o’clock [transpancreatic precut sphincterotomy (TPS)] with guidewire inserted and left in the PD (TPS); D: The bile duct orifice exposed to the left and below the pancreatic orifice (TPS). And then common bile duct cannulation after transpancreatic sphincterotomy.

Figure 2 Subject flow in the study. CBD: Common bile duct; DGT: Double-guidewire technique; TPS: Transpancreatic sphincterotomy.