To explore the application of double guidewire and early transpancreatic precut sphincterotomy in difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP), to provide a theoretical basis for the selection of clinical treatment strategies.

A total of 104 patients with difficult biliary cannulation treated at the First People's Hospital of Suqian City from January 2016 to December 2019 were selected. According to the cannulation methods used, 42 patients who were cannulated with double guidewire were included in group A, 23 patients who were cannulated by early transpancreatic precut sphincterotomy were included in group B, and 39 patients who underwent conventional cannulation were included in group C. The success rate of intubation in the three groups was compared, and the incidence of postoperative complications in the three groups was analyzed.

Group B had the highest success rate (95.7%), followed by group A (85.7%) and group C (53.9%). The success rates of intubation in groups A and B were both significantly higher than that in group C (P＜0.05); there was no significant difference in the success rate of intubation between groups A and B (P＞0.05). The incidence of postoperative complications in groups A, B, and C was 14.3%, 26.1%, and 20.5%, respectively; there was no significant differences in the incidence of postoperative complications among the three groups (P＞0.05).

Both double guidewire surgery and early transpancreatic precut sphincterotomy can significantly improve the success rate of difficult biliary cannulation during ERCP, and have a low risk of postoperative complications and good safety.