Bile duct access is the most difficult part of endoscopic retrograde cholangiography (ERCP) performed for the biliary indications of bile duct stones, leak, and stricture. In the past decade there has been an evolution in the technology and approach used to achieve selective biliary cannulation, In the classic approach a standard cannula is placed into the biliary orifice and contrast injected to confirm placement. Subsequently, a long wire is passed by the assistant deeply into the duct and the cannulatome exchange for a sphincterotome which is used to perform papillotomy.