transpapillary wireguided cannulation with standard sphincterotomy. Cannulation was evaluated for duration, number of trials, use of aiding instruments and success rate. Results: Success rate of CBD cannulation and fair dye drainage was reported in 93.3% and 73.3%, 86.7% and 80%, 85% and 70%, 85% and 80% of patients in groups A,B, C and D respectively, with no statistically significant difference among the four groups. The only complication reported in group A was bleeding (three patients). No statistically significant difference among the four groups regarding post-procedural complications was noticed. Conclusion: Suprapapillary needleknife fistulotomy can be used in cirrhotic patients when standard biliary cannulation proves to be difficult, it is associated with a high success rate and a low complication risk.