Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١١٢
Figure (19): Cannulation of CBD (Courtesy of Dr. Tarik Zaher)
Major papilla pancreatic cannulation:
Major papilla pancreatic cannulation techniques are similar to those used
for biliary cannulation, with exceptions that the smaller size, the duct
tortuousity, and the multiple side branches render deep wire passage more
difficult in some cases. As biliary cannulation may be aided by placement
of a pancreatic guidewire, placement of a biliary guidewire may serve to
straighten the common channel and to improve pancreatic access.
Pancreatic cannulation may either be facilitated or rendered more difficult
by prior biliary sphincterotomy. Repeated access of the pancreatic duct
immediately after biliary sphincterotomy for sphincter of Oddi
dysfunction has 98% success rate (Tarnasky et al., 1998).
Minor Papilla cannulation:
The minor papillary orifice typically is located cephalad to the major
papilla at approximately the 1 to 2 Oclock position to the major papilla as
seen through a duodenoscope. The approach to minor papilla cannulation
varies with anatomy (presence or absence of pancreas divisum)
(Catalano et al., 2003).