Transpancreatic sphincterotomy with double guidewire and pancreatic prothesis after involuntary passage of the guidewire to the pancreas in attempts at biliary cannulation.

In this work we review the approach to difficult cannulation situations during ERCP. Among the known options to solve this problem, we suggest a technical variant that we believe can be useful to successfully complete ERCP with complication rates similar to a conventional ERCP, at least in our experience. To do this, we reviewed 1488 ERCPs and the 23 cases in which we applied this technical variant with its results and complications.