Table 1.

ERCP cannulation techniques in patients with normal anatomy

Technical methods

Standard techniques

Catheters

Papillotomes

Guide wires in conjunction with catheters and papillotomes

Placement of pancreatic stent or guide wire to facilitate cannulation

Precut techniques

Precut papillotomy (needle knife papillotomy)

Transpapillary pancreatic sphincterotomy (precut pancreatic sphincterotomy)

Suprapapillary puncture of the common bile duct (needle knife fistuolotomy)

Endoscopic ultrasound-guided cholangiography

Pharmacologic methods

Minor papilla

Intravenous injection of Secretin

Topical Methylene blue

Intraduodenal acid infusion

Major papilla

Intravenous injection of CCK

Topical nitroglycerin

Fatty meal before ERCP

ERCP: Endoscopic retrograde cholangiopancreatography; CCK: Cholecystokinin.