Endoscopy 2019; 51(09): 852-857
DOI: 10.1055/a-0835-5900
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Comparison between a rotatable sphincterotome and a conventional sphincterotome for selective bile duct cannulation

Akira Kurita
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Yasushi Kudo
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Kenichi Yoshimura
2  Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
,
Tadamasa Takemura
3  Graduate School of Applied Informatics, University of Hyogo, Kobe Chuo-ku, Hyogo, Japan
,
Yoshiharu Mori
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Shunjiro Azuma
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Makoto Sono
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Kohei Yamakawa
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Koutarou Watanabe
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Satoshi Nishimura
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Hiroki Yamashita
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Shinsuke Akiyama
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Mayuki Omatsu
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
,
Shujiro Yazumi
1  Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
› Author Affiliations
TRIAL REGISTRATION: Single-center, randomized, prospective study UMIN000018032 at http://www.umin.ac.jp
Further Information

Publication History

submitted 16 March 2018

accepted after revision 22 December 2018

Publication Date:
13 February 2019 (online)

Abstract

Background Selective biliary cannulation (SBC) is the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially for trainees, and a rotatable sphincterotome may be useful to guide the directional axis of the scope and SBC.

Methods We performed a prospective randomized single-center trial, enrolling 200 patients with a native papilla who required therapeutic biliary ERCP. Patients were randomly assigned to the rotatable sphincterotome group (n = 100) or the conventional sphincterotome group (n = 100). The primary endpoint was successful SBC by the trainees within 10 minutes.

Results The early and late cannulation success rates did not differ significantly between the groups (P = 0.46 and P > 0.99, respectively). For the patients in whom trainees failed to achieve SBC, the rotatable sphincterotome was used as a rescue cannulation technique in four patients from the conventional group; in no patients in the rotatable group was the conventional sphincterotome used for SBC. Post-ERCP pancreatitis (PEP) occurred in 11 patients (5.5 %; 6 mild, 5 moderate); the incidence did not differ significantly between the two groups (rotatable group 3 %, conventional group 8 %; P = 0.21). The two groups were thus combined for evaluation of the factors relating to cannulation difficulty for trainees, which revealed that orientation of the papilla was a significant factor (P < 0.001).

Conclusions The type of sphincterotome used did not affect the success of SBC by trainees. However, orientation of the papilla was revealed to be a significant factor relating to cannulation difficulty for trainees overall.