Selective cannulation of the cystic duct at time of ERCP.

Although the cystic duct can sometimes be cannulated at ERCP, no one has attempted a prospective study of how often this can be done, nor have the potential indications been evaluated. Accordingly, 50 consecutive patients with a variety of pancreaticobiliary conditions were studied prospectively. In 86% of the patients, free cannulation of the common bile duct was accomplished; in 74%, the cannula could be inserted selectively into the cystic duct. Such direct access to the gallbladder may lead to: 1) better gallbladder visualization at time of ERCP, 2) retrieval of pure gallbladder bile for culture and sensitivity on chemical analysis, and 3) gallstone dissolution or extraction.