How to cannulate? A survey of the Scandinavian Association for Digestive Endoscopy (SADE) in 141 endoscopists

J. Matthias Löhr, Lars Aabaken, Urban Arnelo, Juha Grönroos, Jorma Halttunen, Truls Hauge, Eduard Jonas, Per M. Kleveland, Palle Nordblad Schmidt, Fredrik Swahn, Arto Saarela, Ervin Toth, Søren Meisner

Research output: Contribution to journalArticle

9 Citations (Scopus)


Cannulation of the papilla vateri represents an enigmatic first step in endoscopic retrograde cholangiopancreaticography (ERCP). In light of falling numbers of (diagnostic) ERCP and novel techniques, e.g. short-wire system, we were interested in the approach novice and experienced endoscopist are taking; especially, what makes a papilla difficult to cannulate and how to approach this. We devised a structured online questionnaire, sent to all endoscopists registered with SADE, the Scandinavian Association for Digestive Endoscopy. A total of 141 responded. Of those, 49 were experienced ERCP-endoscopists (>900 ERCPs). The first choice of cannulation is with a sphincterotome and a preinserted wire. Both less experienced and more experienced endoscopists agreed on the criteria to describe a papilla difficult to cannulate and both would choose the needle-knife sphincterotomy (NKS) to get access to the bile duct. The less experienced used more "upward" NKS, whereas the more experienced also used the "downward" NKS technique. This survey provides us with a database allowing now for a more differentiated view on cannulation techniques, success, and outcome in terms of pancreatitis.

Original languageEnglish
Pages (from-to)861-869
Number of pages9
JournalScandinavian journal of gastroenterology
Issue number7
Publication statusPublished - Jul 1 2012



  • ERCP
  • cannulation
  • needle-knife sphincterotomy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Löhr, J. M., Aabaken, L., Arnelo, U., Grönroos, J., Halttunen, J., Hauge, T., Jonas, E., Kleveland, P. M., Nordblad Schmidt, P., Swahn, F., Saarela, A., Toth, E., & Meisner, S. (2012). How to cannulate? A survey of the Scandinavian Association for Digestive Endoscopy (SADE) in 141 endoscopists. Scandinavian journal of gastroenterology, 47(7), 861-869.