Double Guidewire Technique (DGT) For Difficult ERCP Cannulation Peter R. McNally, DO, FASGE, FACG...
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Transcript of Double Guidewire Technique (DGT) For Difficult ERCP Cannulation Peter R. McNally, DO, FASGE, FACG...
Double Guidewire Technique (DGT)For Difficult ERCP Cannulation
Double Guidewire Technique (DGT)For Difficult ERCP Cannulation
Peter R. McNally, DO, FASGE, FACG
University Colorado Denver
School of Medicine
Center for Human Simulation
Aurora, Colorado 80045
McNally.VHJOE.ERCP.TR.2010.No4
Figure 1. Injection of contrast into the Pancreatic Duct (PD)Figure 1. Injection of contrast into the Pancreatic Duct (PD)
PD
Cannula Tip
Fig 2. Double Guidewire Technique (DGT)Fig 2. Double Guidewire Technique (DGT)
Endoscopic view of guidewire in the ampullary Os.
Still fluroscopic view of a guidewire in the pancreatic duct.
Fig 3. Double Guidewire Technique (DGT)Fig 3. Double Guidewire Technique (DGT)
Endoscopic view of guidewire in ampullary Os. ERCP cannula adjacent to guidewire. ERCP scope is
then rotated slightly left to visualize the ampullary Os.
Fig 4. Double Guidewire Technique (DGT)Fig 4. Double Guidewire Technique (DGT)
With cannula gently engaged in the Os, 2nd guidewire is advanced through cannula into the CBD
Still fluroscopy illustrating guidewire in PD, cannula in Os, and 2nd guidewire in CBD
Fig 5. Double Guidewire Technique (DGT)Fig 5. Double Guidewire Technique (DGT)
Still Fluroscopy illustrating, guidewire in PD and cannula in CBD.
Endoscopic view of guidewire in PD, cannula filled with yellow bile in the CBD.
Fig 6. Double Guidewire Technique (DGT)Fig 6. Double Guidewire Technique (DGT)
Guidewire in PD, contrast injection into CBD
Endoscopic view of guidewire in PD, cannula in CBD filled with yellow bile.
Fig 7. Double Guidewire Technique (DGT)Fig 7. Double Guidewire Technique (DGT)
Additional Opacification of the CBD with contrast
Endoscopic view of guidewire in PD, cannula in CBD filled with yellow bile.
Double Guidewire Technique (DGT)Double Guidewire Technique (DGT)
Removal of guidewire from PD, opacification of the CBD