Ismail A, Abdelwahab MM, Ozercan M, Elnahas O, Bahcecioglu IH, Yalniz M, Tawheed A. Strategies for achieving successful cannulation in endoscopic retrograde cholangiopancreatography: A technical overview. World J Gastrointest Endosc 2025; 17(7): 107810 [DOI: 10.4253/wjge.v17.i7.107810]
Corresponding Author of This Article
Ahmed Tawheed, Consultant, Department of Gastroenterology, Firat University, Elazig, Firat Campus, Elazig 23119, Türkiye. atawheed1990@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 107810 Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.107810
Strategies for achieving successful cannulation in endoscopic retrograde cholangiopancreatography: A technical overview
Alaa Ismail, Maya M Abdelwahab, Mubin Ozercan, Osama Elnahas, Ibrahim H Bahcecioglu, Mehmet Yalniz, Ahmed Tawheed
Alaa Ismail, Maya M Abdelwahab, Osama Elnahas, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Mubin Ozercan, Ibrahim H Bahcecioglu, Mehmet Yalniz, Ahmed Tawheed, Department of Gastroenterology, Firat University, Elazig 23119, Türkiye
Co-first authors: Alaa Ismail and Maya M Abdelwahab.
Author contributions: All authors have contributed to this article and have approved the final version of the manuscript; Tawheed A designed the overall concept and outline of the manuscript; Ismail A and Abdelwahab MM wrote the manuscript; Elnahas O conducted the database search; Ozercan M revised the manuscript; Bahcecioglu IH and Yalniz M provided important technical details and revised the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed Tawheed, Consultant, Department of Gastroenterology, Firat University, Elazig, Firat Campus, Elazig 23119, Türkiye. atawheed1990@gmail.com
Received: March 31, 2025 Revised: April 24, 2025 Accepted: June 7, 2025 Published online: July 16, 2025 Processing time: 102 Days and 9.7 Hours
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders. Since its inception in the late 20th century, ERCP has transitioned from a mostly diagnostic instrument to a chiefly interventional procedure, owing to the emergence of less invasive imaging techniques like magnetic resonance cholangiopancreatography and endoscopic ultrasonography. Successful biliary cannulation is the most important and difficult step of the procedure. However, there are many challenges associated with cannulation, such as the anatomy of the major duodenal papilla, the direction of the common bile duct and pancreatic duct in the ampulla of Vater, the presence of periampullary diverticula, and scope position. Advanced techniques for cannulation are necessary when basic techniques fail. Double guidewire, precut methods, and transpancreatic sphincterotomy are examples of these advanced techniques. This review aims to summarize the challenges of biliary cannulation and tips for performing cannulation techniques.
Core Tip: Endoscopic retrograde cholangiopancreatography is a crucial diagnostic and therapeutic technique for biliary and pancreatic disorders. Challenges include anatomy, duct direction, diverticula, and scope position. Advanced techniques are needed for successful cannulation. In this review, we discuss the challenges and the advanced techniques of cannulation.
