Endoscopic procedures
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After an overnight fast, all patients underwent ERCP in the prone position with a standard duodenoscope (TJF 260, Olympus Optical, Tokyo, Japan) after sedation with intravenous midazolam (0.05 mg/kg) and/or propofol (0.5 mg/kg). Prophylactic antibiotics and analgesics were permitted. Prophylactic rectal NSAID was not used in this study because of unavailability of this drug in Korea. All ERCP procedures were performed by experienced four endoscopists (> 3000 career ERCPs with a workload of at least 350 ERCPs annually) without involvement of trainees. The GW was controlled by experienced subspecialized endoscopy nursing staffs with at least two years of training.Wire-guided cannulation (WGC) of the bile duct was undertaken using a long-wire technique. For a WGC, a hydrophilic-tipped GW (TRUwire, Sungwon Med. Corp., Korea or VigiGlide 2, Olympus, Japan) with a diameter of 0.025 inch was preloaded into a conventional cannula (Glo-Tip® ERCP Catheter, GT-1-T, Cook Medical, Bloomington, IN, USA) or pull-type sphincterotome (CleverCut3V sphincterotome, Olympus, Japan; Tri-Tome pc®, Cook Medical, Bloomington, IN, USA). The cannula or papillotome was oriented from the 11 to 12 o’clock position on the papilla and bowed to align it correctly with the axis of the bile duct. After a minimal insertion (2–3 mm) of the pull-type papillotome or cannula in the ampulla, the GW was carefully advanced through the CBD under fluoroscopy until it was seen to enter the bile duct (Touch technique)In cases of difficult biliary cannulation (DBC) according to the ESGE guideline