Feasibility of newly designed rotatable sphincterotome for endoscopic sphincterotomy (with video)

Abstract

Background and study aims Endoscopic sphincterotomy can be challenging especially in patients with surgically altered anatomy. Although a rotatable sphincterotome (r-sphincterotome) may be useful, its rotational function is often inadequate. We evaluated the feasibility of a newly designed r-sphincterotome equipped with a well-conceived cutting wire.

Methods We measured the movement and dynamics of both the newly designed r-sphincterotome and two existing r-sphincterotomes using in-house equipment. Ideally, the rotational force exerted at the proximal end should transmit directly to the distal end. But it is often challenging, particularly within the constraints of a bent endoscope and working channel. We collected data regarding deviation from the ideal value 10 times for each sphincterotome.

Results The deviation from the ideal value was significantly lower with the newly designed r-sphincterotome than with the conventional r-sphincterotomes (44.9 ± 27.8 vs. 73.7 ± 44.6 and 130.1 ± 71.4 degrees, respectively; P < 0.001). The newly designed r-sphincterotome rotated smoothly and consistently at a constant speed, mirroring the input rotation.

Conclusions We evaluated the feasibility of the newly designed r-sphincterotome using an experimental model. We believe that the findings from these experiments may contribute to easier and more precise sphincterotomies.

Keywords

Pancreatobiliary (ERCP/PTCD) - ERC topics - Quality and logistical aspects - Training - Quality management - Performance and complications

• References

• 1 Ryozawa S, Itoi T, Katanuma A. et al. Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy. Dig Endosc 2018; 30: 149-173
• 2 Kurita A, Kudo Y, Yoshimura K. et al. Comparison between a rotatable sphincterotome and a conventional sphincterotome for selective bile duct cannulation. Endoscopy 2019; 51: 852-857
• 3 Bedogni G, Bertoni G, Contini S. et al. Endoscopic sphincterotomy in patients with Billroth II partial gastrectomy: comparison of three different techniques. Gastrointest Endosc 1984; 30: 300-304
• 4 Shimatani M, Matsushita M, Takaoka M. et al. Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series. Endoscopy 2009; 41: 849-854
• 5 Hori Y, Naitoh I, Miyabe K. et al. Simultaneous side-by-side bilateral metal stent placement using a colonoscope in a patient with Billroth II reconstruction. Endoscopy 2018; 50: E218-E219
• 6 Bergman JJ, van Berkel AM, Bruno MJ. et al. A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastrointest Endosc 2001; 53: 19-26
• 7 Bergman JJ, Rauws EA, Fockens P. et al. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones. Lancet 1997; 349: 1124-1129
• 8 Vlavianos P, Chopra K, Mandalia S. et al. Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial. Gut 2003; 52: 1165-1169
• 9 Fujita N, Maguchi H, Komatsu Y. et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial. Gastrointest Endosc 2003; 57: 151-155
• 10 Disario JA, Freeman ML, Bjorkman DJ. et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology 2004; 127: 1291-1299
• 11 Maydeo A, Borkar D. Techniques of selective cannulation and sphincterotomy. Endoscopy 2003; 35: S19-S23
• 12 Mirjalili SA, Stringer MD. The arterial supply of the major duodenal papilla and its relevance to endoscopic sphincterotomy. Endoscopy 2011; 43: 307-311