The double-wire technique as an aid to selective cannulation of the common bile duct during pediatric endoscopic retrograde cholangiopancreatography

BACKGROUND: Selective cannulation of the common bile duct (CBD) during endoscopic retrograde cholangiopancreatography (ERCP) can be difficult. Several techniques have been described to assist endoscopists in obtaining access when initial cannulation fails. The objective of this report is to describe our initial experience with the "double-wire technique" in the pediatric population. PATIENTS AND METHODS: Sixty ERCPs were performed in children with ages ranging from 8 months to 18 years and the technique was used in 8 cases. After wire-guided access to the pancreatic duct is obtained, the wire is left in place within the pancreatic duct to aid subsequent selective cannulation of the CBD. RESULTS: In 2 of these cases, transient increase in pancreatic enzymes was observed after ERCP. Nevertheless, in this small series of patients it was found to be an effective and useful tool in cases in which repeated attempts have yielded only pancreatic duct cannulation. CONCLUSIONS: This technique is a useful aid for the endoscopist attempting to selectively cannulate the CBD in difficult cases. Further study will be needed to establish the safety of this technique in the pediatric population.