Please select the eligibility criteria that correspond to the clinical trial below.
Title: Double Guide Wire Placement Compared With Conventional Method in Cases of Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography Procedures. A Controlled Multicentred Randomized Trial.
Brief Summary: The purpose of this study is to determine if the double guide wire technique is more effective than the conventional method in those cases of difficult selective biliary cannulation in the ERCP procedures.


Options:
A: Inclusion Criteria:

1 Subjects who are undergoing endoscopic retrograde cholangiopancreatography (ERCP)

* Age \> 18 years
* Non-pregnant
* Non-prisoners
* Subjects who can sign informed consent
* Serum Creatinine \< 1.2 milligrams/deciliter (mg/dL)
* Subjects without renal failure (acute or chronic)
* Subjects without congestive heart failure (ejection fraction \< 40%)
* Subjects without cirrhosis of the liver
* Subjects without allergy to aspirin or non-steroidal anti-inflammatory drugs (NSAIDS)
* Subjects not on non-steroidal anti-inflammatory drugs NSAIDS prior to enrollment

Exclusion Criteria:

* Subjects who are not undergoing ERCP
* Age \< 18 years
* Pregnancy
* Prisoners
* Subjects lacking the capacity to consent for themselves
* Serum Creatinine \> 1.2 milligrams/deciliter (mg/dL)
* Subjects with renal failure (acute and chronic)
* Subjects with congestive heart failure (ejection fraction \< 40%)
* Subjects with cirrhosis of the liver
* Subjects with allergy to aspirin or non-steroidal anti-inflammatory drugs (NSAIDS)
* Subjects with gastrointestinal hemorrhage
* Subjects on chronic non-steroidal anti-inflammatory drugs NSAIDS
* Subjects with acute pancreatitis the day of their procedure (CITE 1-3)(APPENDIX 1)
B: Inclusion Criteria:

* Age over 18 years
* Clinical and/or radiological suspicion of Bile Duct Diseases which require ERCP procedure with intention of selective biliary cannulation
* Patients must be admitted in the participant hospitals of the investigators units
* Written informed consent of the patient, relative or legal tutor

Exclusion Criteria:

* Previous biliary or pancreatic sphincterotomy
* Previous pneumatic dilatation of duodenal papilla
* Presence of biliary-digestive derivation
* Previous diagnosis or suspected pancreas divisum
* Use of any biliary or pancreatic stent in the last 6 months
* Use of any drug aimed to reduce post-ERCP pancreatitis
* Pregnancy or maternal feeding
* Previous inclusion in the study
C: Inclusion Criteria:

* All patients referred for ERCP who have an intact naïve papilla are considered for inclusion

Exclusion Criteria:

* Age \<18yrs
* Acute illness (hypotension: BP\<90mmHg, hypoxia: O2 \<95%, haemodynamic instability)
* Inability or refusal to give informed consent.
* Patients with previous sphincterotomy
* Pancreatic or ampullary cancer are excluded as post-ERCP pancreatitis (PEP) is very uncommon in these subgroups and tumour-related anatomical variation may alter cannulation technique.

(consider substratify results for this subgroup, but exclude if duodenal stenosis precludes an attempt on the papilla)

* Patients with surgically altered anatomy (Bilroth II gastrectomy and Roux en Y anastomosis) are excluded as cannulation technique is fundamentally different from that in normal anatomy.
D: Inclusion Criteria:

* high-risk patients for post-ERCP pancreatitis

Exclusion Criteria:

* age \< 18 years
* allargy to the contrast medium
* previous biliary or gastric surgery
* neoplastic patients
* previous biliary or pancreatic sphincterotomy

Answer: B