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🎯 3 Teaching Pearls from the “Compact Disc” Method for ERCP Cannulation 1️⃣ Visualize the invisible. Imagine stacked CDs inside the papilla to conceptualize the 3D bile duct axis—especially in long oral protrusion (LOP). 2️⃣ Advance gently, not forcefully. Cannulation should feel like passing through the center hole of...

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Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD

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🔴Nice teaching case for the advanced therapeutic fellow ERCP Teaching Pearl 🧠 | Hock-Pull Technique in Supine Position 🛌 Supine patient = altered orientation → technique matters 🔹 Papilla orientation: In supine ERCP, the papilla often appears more inferior/posterior and less en face, with a tendency for the catheter to fall into the pancreatic duct due to gravity and scope torque. 🔹 Why Hock-Pull helps: • Hockey bow redirects the tip upward toward the biliary axis despite gravity. • Gentle pull-back everts and opens the papillary orifice, counteracting the “downward fall” seen in supine cases. • Improves coaxial alignment (~11 o’clock) without pushing. 🔹 Manoeuvrability advantage: • Pulling back stabilizes the papilla against respiratory motion. • Small rotations become effective—micro-adjustments instead of force. • Reduces repeated pancreatic duct entry and papillary trauma. 💡 Pearl: > “In supine ERCP, gravity favors the pancreas—hock-pull brings you back to bile.” #ERCP #SupineERCP #Endoscopy #GI #TeachingPearls #PatientSafety
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🔴Nice teaching case for the advanced therapeutic fellow ERCP Teaching Pearl 🧠 | Hock-Pull Technique in Supine Position 🛌 Supine patient = altered orientation → technique matters 🔹 Papilla orientation: In supine ERCP, the papilla often appears more inferior/posterior and less en face, with a tendency for the catheter to fall into the pancreatic duct due to gravity and scope torque. 🔹 Why Hock-Pull helps: • Hockey bow redirects the tip upward toward the biliary axis despite gravity. • Gentle pull-back everts and opens the papillary orifice, counteracting the “downward fall” seen in supine cases. • Improves coaxial alignment (~11 o’clock) without pushing. 🔹 Manoeuvrability advantage: • Pulling back stabilizes the papilla against respiratory motion. • Small rotations become effective—micro-adjustments instead of force. • Reduces repeated pancreatic duct entry and papillary trauma. 💡 Pearl: > “In supine ERCP, gravity favors the pancreas—hock-pull brings you back to bile.” #ERCP #SupineERCP #Endoscopy #GI #TeachingPearls #PatientSafety

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