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.
View of pylorus. Bubbles indicating bile provide a clue to the location of the distal stomach when orientation of the side-viewing endoscope is difficult.