Two-sphincterotomes-in-one-channel method: help in cannulation and sphincterotomy.

Deep cannulation of the desired channel (biliary or pancreatic) is the basic requirement to successfully perform a therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In biliary cannulation, we have a broad armamentarium of standard and specialized techniques. However, failure rates can range from 1-10%. The consequences of failure in cannulation are serious: repetition of the ERCP, alternative procedures with morbidity and significant cost, as well as higher rates of complications (1). Therefore new techniques are arising that attempt to improve results without increasing these adverse effects. The performance of sphincterotomy is another very important step in completing biliary therapy (2). However, on some occasions the sphincterotomy is made more difficult due to the presence of a transverse duodenal fold that covers the papilla of Vater and impedes the safe completion of this technique.