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With the development of the modern technology and medicine, many advanced equipments came into being. ERCP Instruments are one of them.

Endoscopic retrograde cholangiopancreatography (ERCP) is a combined endoscopic and fluoroscopic procedure in which an upper endoscope is led into a second part of the duodenum, making it possible for passage of other tools via the major duodenal papilla into the biliary and pancreatic ducts. Contrast material may be injected in these ducts, allowing for radiologic visualization and therapeutic interventions when indicated. ERCP initially started as a diagnostic procedure through cannulation of the pancreatic and biliary ducts but has evolved over the years to a predominantly therapeutic tool. Difficult biliary cannulation is proposed to be defined as cannulation attempts duration of more than 5 minutes, more than five cannulation attempts, or at least two pancreatic guidewire passages. Direct visualization of the ducts is done through cholangiopancreatoscopy.

The side-viewing duodenoscope is considered the standard for ERCP procedure as it allows a better view of the major duodenal papilla, rendering cannulation easier. In patients with reconstructed gastrointestinal anatomy, as in patients with Billroth II gastrectomy or Roux-en-Y operation, the afferent loop entrance is hidden, and at a sharp angle, the afferent loop is elongated, and the papillary position is reversed. In these situations, the traditional side-viewing endoscope provides a limited visual field and makes afferent loop intubation challenging, thus increasing the risk for intestinal injuries. A forward-viewing endoscope may be a reasonable alternative in these circumstances, where afferent loop intubation would be easier, but papillary cannulation would be more challenging. The reversed papillary position makes it difficult for both side-viewing and forward-viewing endoscopes. The double-balloon enteroscopy technique uses two balloons to advance the forward-viewing endoscope through the intestine by alternating inflating and deflating balloons.
http://www.mednovahz.com/gastroenterology-instruments/ercp-instruments/