Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy
(EST) is an effective and safe treatment for common bile duct (CBD) stones in patients
with Roux-en-Y anastomosis [1]
[2]. However, performing EST using the conventional sphincterotomy approach in these
patients is considered difficult because it has to be done in the opposite direction
[3]
[4]. The direction of the blade does not correspond with the correct incision direction
(axis of the bile duct) in this situation. It is desirable, therefore, for the blade
to be oriented in the appropriate incision direction in patients with Roux-en-Y anastomosis
([Fig. 1]).
Fig. 1 Orientation for endoscopic sphincterotomy in patients with Roux-en-Y anastomosis.
Left panel: with the conventional sphincterotomy approach, the direction of the blade
(arrow b) does not correspond with the correct incision direction (arrow a; axis of
the bile duct). Right panel: a blade oriented in the appropriate incision direction
(arrow) is desirable in these patients.
The Correctome (Boston Scientific, Marlborough, Massachusetts, USA) is a new sphincterotomy
device that allows optimal orientation of the blade. The blade of the Correctome can
be stretched for the conventional sphincterotomy approach. Furthermore, this blade
can be loosened in the opposite direction, resulting in wide bowing ([Fig. 2]).
Fig. 2 The Correctome (Boston Scientific, Marlborough, Massachusetts, USA) is a new sphincterotomy
device that allows optimal orientation of the blade. Left panel: the blade can be
stretched for the conventional sphincterotomy approach. Right panel: the blade can
be loosened in the opposite direction.
A 69-year-old man who had undergone total gastrectomy with Roux-en-Y anastomosis was
admitted to our hospital for the treatment of CBD stones. A short-type single-balloon
enteroscope (SIF-H290; Olympus Medical Systems, Tokyo, Japan) was inserted into the
papilla, and selective biliary cannulation was successfully performed [5]. Next, the Correctome was intubated into the papilla over the guidewire, and the
blade was loosened to achieve wide bowing. The direction of the blade was turned towards
the bile duct axis without any adjustment ([Fig. 3]). The opening to the ampulla was enlarged by cutting ([Fig. 4]), and EPLBD was performed ([Fig. 5]). All stones were successfully removed.
Fig. 3 The Correctome (Boston Scientific, Marlborough, Massachusetts, USA) was intubated
into the papilla over the guidewire, and the blade was loosened to achieve wide bowing.
The direction of the blade was turned towards the bile duct axis without any adjustment.
Fig. 4 The opening to the ampulla was enlarged by cutting.
Fig. 5 After endoscopic sphincterotomy, endoscopic papillary large balloon dilation was
performed. All stones were successfully removed. Left panel: endoscopic image. Right
panel: fluoroscopic image.
This novel sphincterotomy device that allows orientation of the blade along the axis
of the bile duct is considered useful for EST, not only for patients with normal anatomy
but also for patients with Roux-en-Y anastomosis ([Video 1]).
Video 1 Novel sphincterotomy approach with blade that can be oriented along the axis of the
bile duct in patients with Roux-en-Y anastomosis.
Endoscopy_UCTN_Code_TTT_1AS_2AG
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
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