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)

PD

Cannula Tip

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)

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)

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)

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)

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)

Additional Opacification of the CBD with contrast

Endoscopic view of guidewire in PD, cannula in CBD filled with yellow bile.

Double Guidewire Technique (DGT)Removal of guidewire from PD,

opacification of the CBD