Abstract
Selective bile duct cannulation is the prerequisite for all endoscopic biliary therapeutic interventions, but this cannot always be achieved easily. Despite advances and new developments in endoscopic accessories, selective biliary access fails in 5%-15% of cases, even in expert high-volume centers. Various techniques, such as double-guidewire induced cannulation, pre-cut papillotomy or trans pancreatic sphincterotomy with or without placement of a pancreatic stent, have been used to improve cannulation success rates. Repeated and prolonged attempts at cannulation increase the risk of pancreatitis. These techniques have been reported in adults, but there are no data on their use in children.
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