Standard devices and techniques

Selective cannulation is the most important part of ERCP because all therapeutic techniques depend upon it. Sphincterotomy is the most dangerous aspect because of the potential adverse events. The success of ERCP (cannulation) depends on understanding the "AOA," which stands for Axis, Orientation, and Alignment. The key to avoid problems is in the "AXIS," which denotes correct Alignment with the appropriate axis, appropriate use of X-ray of fluoroscopy to obtain a three-dimensional image of the target organ for the procedures and to stay on track, and to have a real Indication for the procedure, and, finally, Selective cannulation to get into the respective ductal system and avoid unnecessary or overfilling (mostly of the pancreas). This chapter attempts to explain how to do the many diagnostic and therapeutic techniques that can be performed by ERCP. Details of preparation, indications, outcomes, and adverse events are discussed elsewhere.