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DOI: 10.1055/s-0029-1243857
© Georg Thieme Verlag KG Stuttgart · New York
Precut sphincterotomy using insulated angulotome
Publication History
submitted 5 November 2009
accepted after revision 26 November 2009
Publication Date:
09 February 2010 (online)
![](https://www.thieme-connect.de/media/endoscopy/201004/lookinside/thumbnails/10.1055-s-0029-1243857-1.jpg)
A newly designed insulated angulotome was evaluated in a series of patients in whom biliary cannulation using conventional methods had failed and who required precut sphincterotomy. The new device consists of an insulated glass tip to prevent excessive electrocautery flow, and angulation to facilitate elevation of the papillary roof on cutting. A prospective series of patients with cholangitis or obstructive jaundice with failed biliary cannulation were recruited. The success of cannulation and complications following endoscopic retrograde cholangiopancreatography were analyzed. A total of 13 patients underwent precut sphincterotomy using the insulated angulotome. The immediate success of gaining biliary access after failed cannulation was 100 %. The mean size of the common bile duct on ultrasonography was 8.1 mm. The mean time to achieve biliary cannulation was 9 minutes 4 seconds, and there was no perforation or bleeding. This case series showed that precut sphincterotomy with the insulated angulotome can be safely performed without major complications.
References
- 1 Freeman M L, Guda N M. ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005; 61 112-125
- 2 Gotoh Y, Tamada K, Tomiyama T. et al . A new method for deep cannulation of the bile duct by straightening the pancreatic duct. Gastrointest Endosc. 2001; 53 820-822
- 3 Vandervoort J, Carr-Locke D L. Needle knife access papillotomy: an unfairly maligned technique?. Endoscopy. 1996; 28 365-366
- 4 Dowsett J F, Polydorou A A, Vaira D. et al . Needle knife papillotomy: how safe and how effective?. Gut. 1990; 31 905-908
- 5 Tweedle D E, Martin D F. Needle knife papillotomy for endoscopic sphincterotomy and cholangiography. Gastrointest Endosc. 1991; 37 518-521
- 6 Rollhauser C, Johnson M, Al K awas. Needle-knife papillotomy: a helpful and safe adjunct to endoscopic retrograde cholangiopancreatography in a selected population. Endoscopy. 1998; 30 691-696
- 7 Osnes M, Kahrs T. Endoscopic choledochoduodenostomy for choledocholithiasis through choledochoduodenal fistula. Endoscopy. 1977; 9 162-165
- 8 Bruis S W, Schoeman M N, Disario J A. et al . Needle knife sphincterotomy as a precut procedure: a retrospective evaluation of efficicy and complications. Endsocopy. 1996; 28 334-339
- 9 Wang P, Li Z S, Liu F. et al . Risk factors for ERCP related complications: a prospective multicenter study. Am J Gastroenterol. 2009; 104 31-40
- 10 Sriram P VJ, Rao G V, Reddy D N. The precut – when, where and how?. Endoscopy. 2003; 35 S24-30
- 11 De Weerth A, Seitz U, Zhong Y. et al . Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy. 2006; 38 1235-1240
- 12 Kaffes A J, Sriram P VJ, Rao G V. et al . Early institution of precutting for difficult biliary cannulation: a prospective study comparing conventional vs a modified technique. Gastrointest Endosc. 2005; 62 669-674
P. W. Y. ChiuMD
Department of Surgery
Prince of Wales Hospital
The Chinese University of Hong Kong
30–32 Ngan Shing Street
Shatin
NT Hong Kong 000000
Hong Kong
Fax: +852-26377974
Email: philipchiu@surgery.cuhk.edu.hk