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Aabakken et al. Mini-invasive Surg 2021;5:25 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.09

Review Open Access

How to access the common bile duct

1
Lars Aabakken , Purnima Bhat 2
1
Dept of transplantation medicine, Oslo University Hospital, and Faculty of Medicine, University in Oslo, Oslo 0027, Norway.
2
Gastroenterology and Hepatology Unit, Canberra Hospital, and College of Health and Medicine, Australian National University,
Gilmore Cres, Garran ACT 2605, Canberra, Australia.
Correspondence to: Prof. Lars Aabakken, Dept of Transplantation Medicine, OUS-Rikshospitalet, Sognsvannsv 20, OSLO 0027,
Norway. E-mail: larsaa@medisin.uio.no

How to cite this article: Aabakken L, Bhat P. How to access the common bile duct. Mini-invasive Surg 2021;5:25.
https://dx.doi.org/10.20517/2574-1225.2021.09

Received: 25 Jan 2020 First Decision: 20 Feb 2021 Revised: 3 Mar 2021 Accepted: 23 Mar 2021 Published: 11 May 2021
Academic Editor: Jean François Rey Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Biliary access is a prerequisite to all endoscopic interventions in the biliary tract. Successful cannulation of the
papilla of Vater is the predominant challenge for the majority of endoscopists training in endoscopic retrograde
cholangiopancreaticography (ERCP), and the skills required for success differ substantially from those of regular
luminal endoscopy. This paper reviews some of the key elements to successful biliary cannulation, a range of
options for problem-solving when cannulation is difficult, and some tips and tricks in select special situations as
well. The techniques are described, and available evidence is reviewed.

Keywords: Endoscopy, ERCP, endoscopic interventions, cannulation, papilla of Vater

INTRODUCTION
Endoscopic retrograde cholangiopancreaticography (ERCP) has since its inception 50 years ago been
considered one of the most sophisticated, challenging and risky endoscopy procedures. Although recent
advances in available accessories and imaging have reduced risks, it remains a complex procedure, requiring
skills and training different from luminal endoscopy, from where most endoscopists arrive. It also requires
access to - and understanding of - cross-sectional imaging and ductal anatomy.

The procedure may include a number of different elements, but common to all is the necessity to cannulate
the papilla and achieve deep access to the desired duct, most often the bile duct. Successful cannulation of

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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