Laparoscopic Intra-operative Cholangiography using catheter inside cystic duct and instillation of radio-paque agent.
Sometimes bile duct cannulation requires orientation of the cannula in a cephalad direction. This can be accomplished by using a sphincterotome. Tightening the cutting wire bows the cannula upward and produces a more cephalad orientation for the tip of th
Lifting the cannula to insert it along the “roof ” of the papilla increases the likelihood of entry into the bile duct.
The “tucked under” position is usually obtained by advancing the endoscope slightly and deflecting the tip upward.
The septum separating the orifices to the pancreatic and bile ducts can be oriented in any direction from horizontal to vertical. When the papilla is viewed en face, the course of the bile duct is usually toward the 10 o’clock position and the pancreatic
The proper cannulation angle for the pancreatic duct is nearly at right angles to the duodenal wall, while bile cannulation requires a more cephalad orientation.