Clin Endosc.  2024 Jan;57(1):96-104. 10.5946/ce.2022.248.

Rotatable sphincterotome as a rescue device for endoscopic retrograde cholangiopancreatography cannulation: a single-center experience

• Okamoto T
• Sasaki T
• Takeda T
• Mie T
• Mori C
• Furukawa T
• Yamada Y
• Kasuga A
• Matsuyama M
• Ozaka M
• Sasahira N

• KMID: 2551198
• DOI: http://doi.org/10.5946/ce.2022.248

Abstract

Background/Aims
Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation.
Methods
We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021.
Results
TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups.
Conclusions
The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

Keyword

Cannulation; Endoscopic devices; Endoscopic retrograde cholangiopancreatography; Sphincterotome

Figure

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  Fig. 1. TRUEtome rotatable sphincterotome (Boston Scientific).

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  Fig. 2. The use of TRUEtome (Boston Scientific) for difficult cannulation in surgically altered anatomy using a single-balloon enteroscope. (A) The ampulla (arrow) was barely visible, being located within a large periampullary diverticulum. (B) Unsuccessful bile duct cannulation with an endoscopic retrograde cholangiopancreatography catheter (MTW Endoskopie Manufaktur). (C) After switching to TRUEtome, the tip was bowed up slightly and rotated to the 3 o’clock position. (D) The angle and direction of TRUEtome were aligned with the anatomy of the ampulla and bile duct, leading to successful cannulation. (E) Fluoroscopy confirmed successful deep bile duct cannulation and the presence of a common bile duct stone.

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