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. Author manuscript; available in PMC: 2021 Oct 6.
Published in final edited form as: Eur Med J Hepatol. 2021 Aug 5;9(1):73–82.

Figure 2: A proposed management algorithm for difficult biliary cannulation.

Figure 2:

*Patients who have the pancreatic duct cannulated (intentional or inadvertent) should generally have a pancreatic duct stent placed to reduce the risk of post-ERCP pancreatitis, unless an alternative prophylactic measure is deemed to be equally or more clinically appropriate.

†If false tract created, intramural incision can be attempted.

ERCP: endoscopic retrograde cholangiopancreatography; EUS-RV: endoscopic ultrasound-guided rendezvous; PTERV: percutaneous transhepatic-endoscopic rendezvous; PTBD: percutaneous transhepatic biliary drainage.