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CC BY 4.0 · Endoscopy 2025; 57(S 01): E277-E278
DOI: 10.1055/a-2549-2747
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An upgraded rotatable sphincterotome enhances bile duct cannulation via balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography

Yuya Takenaka
1   Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (Ringgold ID: RIN13789)
,
Katsuyuki Miyabe 
1   Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (Ringgold ID: RIN13789)
,
Toshitaka Mori
1   Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (Ringgold ID: RIN13789)
,
Naoki Atsuta
1   Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (Ringgold ID: RIN13789)
,
Yasuki Hori 
2   Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Tomonori Yamada
1   Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (Ringgold ID: RIN13789)
,
Kazuki Hayashi
3   Department of Gastroenterology, Nagoya City University East Medical Center, Nagoya, Japan (Ringgold ID: RIN36975)
› InstitutsangabenGefördert durch: Japan Society for the Promotion of Science KAKENHI grants (JP 22K08036 to Katsuyuki Miyabe)
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Bile duct cannulation via balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) can be challenging, particularly in complex anatomical scenarios [1] [2]. This case report emphasizes the clinical application of a novel rotatable sphincterotome in a 75-year-old man who presented to a local clinic with a 1-week history of bilirubinuria. The patient had a history of gastric cancer and had undergone a distal gastrectomy with Roux-en-Y reconstruction 6 years previously. Laboratory tests revealed elevated liver enzymes, prompting a referral to our hospital. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed mild common bile duct wall thickening and stricture with upstream biliary dilation ([Fig. 1], [Fig. 2]), which was eventually diagnosed as recurrent gastric cancer 6 months after ERCP.

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Fig. 1 Contrast-enhanced computed tomography in a patient with a history of gastric cancer treated with distal gastrectomy and Roux-en-Y reconstruction revealed mild thickening and stricture (arrow) of the common bile duct wall and upstream biliary dilation.
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Fig. 2 Magnetic resonance cholangiopancreatography revealed a stricture of the common bile duct with upstream biliary dilation.

A double-balloon endoscope was used to access the papilla. However, significant challenges prevented successful bile duct cannulation. Retroflex position, a technique often used to facilitate cannulation [3], was unsuccessful due to the narrow duodenal lumen. Furthermore, conventional sphincterotomy failed as the instrument could not rotate adequately under balloon-assisted endoscopy, and the curvature of the knife did not align with the bile duct axis. Subsequently, a novel, upgraded sphincterotome (Aimingtome; Asahi Intecc Co., Ltd., Seto, Japan) was used ([Fig. 3]) [4]. This device features a more rotatable and flexible tip, which enabled guidewire insertion into the duodenal papilla ([Video 1]). The guidewire was then successfully advanced into the main pancreatic duct, facilitating bile duct cannulation via the pancreatic duct guidewire technique. Endoscopic sphincterotomy was performed using the same sphincterotome ([Fig. 4]), followed by the placement of a biliary plastic stent ([Fig. 5]). The patient was discharged 3 days after the procedure. In cases where frontal visualization of the papilla using balloon endoscopy-assisted ERCP is challenging, the use of a novel rotatable sphincterotome can effectively facilitate bile duct cannulation and subsequent endoscopic sphincterotomy.

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Fig. 3 Macroscopic overview of the novel sphincterotome. Source: Asahi Intecc, Seto, Japan.

Qualität:
An upgraded rotatable sphincterotome successfully facilitated bile duct cannulation using balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography. Source for sphincterotome: Asahi Intecc, Seto, Japan.Video 1

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Fig. 4 Endoscopic sphincterotomy using the novel sphincterotome. Compared to a conventional sphincterotome, it allows 360° rotation and greater backward flexibility.
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Fig. 5 Biliary and pancreatic stents placed in the common bile duct and main pancreatic duct: a endoscopic view; b radiographic image

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Artikel online veröffentlicht:
28. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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