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Difficult Biliary Cannulation and Sphincterotomy: What to Do

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a complex and invasive procedure that is associated with adverse events including pancreatitis, bleeding, infection, perforation, cardiopulmonary complications, and rarely death. Technical success of this procedure relies on accessing the bile (and/or pancreatic) duct and being able to perform sphincterotomy safely. Standard cannulation methods are successful in the majority of cases; however, there are times when difficult biliary cannulation is encountered. In this setting advanced techniques for completion are required. Methods for biliary access include double guidewire technique, precut sphincterotomy, transpancreatic sphincterotomy, and others (endoscopic ultrasound or percutaneous transhepatic guided biliary drainage). In this chapter, we aim to review the standard and advanced techniques for biliary cannulation, predictors of difficult cannulation and methods for performing biliary sphincterotomy.

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Authors and Affiliations

  1. Bournemouth Digestive Diseases Centre, Royal Bournemouth Hospital, University Hospitals Dorset, Bournemouth, UK

    Earl J. Williams

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  1. Earl J. Williams
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  2. Babu Krishnan
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  3. Su Yin Lau
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Corresponding author

Correspondence to Earl J. Williams .

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Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Williams, E.J., Krishnan, B., Lau, S.Y. (2021). Difficult Biliary Cannulation and Sphincterotomy: What to Do. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_65-2

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_65-2

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Chapter history

  1. Latest

    Difficult Biliary Cannulation and Sphincterotomy: What to Do
    Published:
    10 August 2021

    DOI: https://doi.org/10.1007/978-3-030-29964-4_65-2

  2. Original

    Difficult Biliary Cannulation and Sphinterotomy: What to Do
    Published:
    09 June 2021

    DOI: https://doi.org/10.1007/978-3-030-29964-4_65-1

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