Post written by Ahmed Altonbary, MD, FRCP, FESGE, from Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt.

We describe the “endoscope traction” technique to facilitate over-the-wire biliary cannulation during EUS-guided rendezvous, an effective salvage technique for failed biliary cannulation during ERCP.

Technically challenging steps in this technique include biliary puncture, guidewire manipulation, and biliary cannulation using the EUS-placed guidewire.

With the endoscope traction technique, the guidewire is retrieved through the endoscopic accessory channel and held with the endoscope elevator followed by endoscope traction outside the patient’s mouth. After both ends of the guidewire are retrieved, the duodenoscope is reinserted over the wire, and biliary cannulation is obtained with the conventional approach.

In conclusion, the endoscope traction technique is an alternative technique that facilitates over-the-wire biliary cannulation during EUS-guided rendezvous.

EUS-guided puncture of the left hepatic duct using a 19-gauge FNA needle.

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