Utility and safety of a new uneven double-lumen sphincterotome in cases of difficult biliary cannulation

Shuhei Shintani,Yoshihisa Tsuji,Takehide Fujimoto,Osamu Inatomi,Yoshiya Takeda,Hiromu Kutsumi,Akira Andoh,Hiroshi Matsumoto

doi:10.1186/s12876-021-01689-6

Shuhei Shintani, Yoshihisa Tsuji + Show 6 more

Open Access

https://doi.org/10.1186/s12876-021-01689-6

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Abstract

BackgroundWe investigated the utility and safety of a new uneven double-lumen sphincterotome in biliary cannulation in comparison with the conventional pancreatic guidewire (PGW) method.MethodsWe retrospectively evaluated 119 patients who required PGW placement because of difficult biliary cannulation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed using a conventional ERCP catheter or a new uneven double-lumen sphincterotome. The success rate of bile duct cannulation, the operation time of bile duct cannulation, and the incidence of post-ERCP pancreatitis (PEP) were evaluated.ResultsForty-four patients were treated with a new double-lumen sphincterotome (the new sphincterotome group) and 75 patients underwent conventional PGW placement (the conventional group). The success rate of bile duct cannulation was 39/44 (88.6%) in the new sphincterotome group and 63/75 (84.0%) in the conventional group (not significant). The total biliary cannulation time (from the reach to the papilla to the finish of biliary cannulation) was 16.0 (6.5–78) min in the new sphincterotome group and 26.0 (5–80) min in the conventional group (P < 0.01). The time from PGW placement to bile duct cannulation was 3.5 (0.3–57) min in the magictome group and 12.0 (1–65) min in the conventional group (P < 0.01). Hyperamylasemia was observed in 13/44 (29.5%) and 17/75 (22.7%), respectively (not significant). Five of 44 (11.3%) of the new sphincterotome group and 14/75 (18.7%) of the conventional group were diagnosed with PEP (not significant).ConclusionA new double-lumen sphincterotome allows selective bile duct cannulation to be performed in a shorter time than the conventional PGW method.

Highlights

We investigated the utility and safety of a new uneven double-lumen sphincterotome in biliary cannulation in comparison with the conventional pancreatic guidewire (PGW) method
Of 119 patients who underwent PGW placement, 44 patients were treated with MagicTome® and 75 patients underwent conventional PGW placement (Fig. 3)
Of 5 patients with bile duct cannulation failure in the magictome group, 3 patients subsequently received precut sphincterotomy, but bile duct cannulation was a failure in 2 patients

Summary

Introduction

We investigated the utility and safety of a new uneven double-lumen sphincterotome in biliary cannulation in comparison with the conventional pancreatic guidewire (PGW) method. Pancreatic guidewire (PGW) placement has been reported to facilitate selective bile duct cannulation [1, 7]. PGW placement stabilizes the mobility of the papilla and linearize the distal part of the bile duct [3], leading to an increased success rate for selective bile duct cannulation. PGW placement includes several steps: cannulation into the pancreatic duct to insert a guidewire, pull off the pancreatic cannula while retaining the guidewire, and cannulation or guidewire insertion into the bile duct [9]. These processes are somewhat complicated and time consuming. Placed PGW sometimes disturbs approach to the common bile duct

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