Biliary endoscopic sphincterotomy: Techniques and complications

Figure 5 Transpancreatic biliary sphincterotomy. A: Pancreatic duct is unintentionally cannulated during biliary cannulation attempts; B: Guidewire is inserted to the pancreatic duct; C: Cutting wire of the sphincterotome is oriented towards 11 o’clock to cut the septum between the pancreatic duct and bile duct; D: Bile duct is cannulated after a 5-Fr plastic stent is inserted to the pancreatic duct for post-endoscopic retrograde cholangiopancreatography pancreatitis prophylaxis.