NEW RENDEZVOUS TECHNIQUE WITH A HOMEMADE MONORAIL SPHINCTEROTOME

Aim:

Rendezvous technique involves some steps. First of all, when the guidewire comes out through the duodenal papilla, the duodenoscope is reintroduced in parallel to the guidewire, so up to this point, there are two options. The first one is to try bile duct cannulation in parallel to the guidewire, with a low rate of success and a long duration of the procedure. The second one is to recover the guidewire through the duodenoscope channel or even the guidewire and the duodenoscope en bloc to pass the guidewire through the endoscope channel outside the patient. This step is time-consuming and there is high possibility of complications, due to the tension that supports the guidewire that can erode and even lacerate the duodenal mucosa or the papilla. So the aim was to design a new rendezvous method to cannulation by homemade assisted monorail sphincterotome.

Methods:

We used a sphincterotome (Autotome ^TMRx 44, 4.4F (1.5 mm) 30 mm, Boston Scientific, USA) a scalpel and a guidewire.

Results:

In the convex part of the distal end of the sphincterotome, we can easily create a < 1 mm wide and 3 mm long rail with a scalpel. The rail allows us to slide the sphincterotome through the guidewire that peeks through the papilla and directly direct it to the papillar orifice, reducing considerably the duration of the procedure and the rate of complications. Through the sphincterotome, the new guidewire is introduced in the choledoco and the rendezvous guidewire is easily removed by pulling the end that comes out of the patient's mouth.

Conclusions:

The usage of a homemade monorail sphincterotome considerably shortens the duration of the rendezvous and decreases the possibility of complications.