What is the direction of pancreatic cannulation during an ERCP?

During an Endoscopic Retrograde Cholangiopancreatography (ERCP), pancreatic cannulation is typically performed in the direction of the 1 to 3 o'clock position. This orientation aligns with how the anatomy of the duodenum and the pancreatic duct is situated relative to the endoscope.

The pancreatic duct is located posterior to the duodenum, and in most cases, cannulation requires navigating the endoscope to the ampulla of Vater, which is where the bile and pancreatic ducts open into the duodenum. By angling the cannula towards the 1 to 3 o'clock position, the endoscopist can effectively engage the pancreatic duct and facilitate the passage of contrast material for imaging or therapeutic interventions.

This understanding of the anatomical landmarks and the technique required for cannulation is crucial for successfully accessing the pancreatic duct while minimizing the risk of complications during the procedure.