Needle-knife electrocautery: 'give me a lever and i will move the world'

摘要

In ERCP, there is no more rewarding time than when passing a guidewire through a difficult biliary/pancreatic stricture after a long-lasting manipulation. Overcoming the stricture means that the procedure will be usually successful eventually. Effective manipulation of a guidewire through challenging biliopancreatic strictures requires patience, skill, knowledge, and correct interpretation of the radiological anatomy, and, last but not least, the availability of catheters and (hydrophilic!) guidewires of different shapes and characteristics.