Abstract
We have attempted precutting procedure by means of the tip of usual papillotome when a selective cannulation to the common bile duct failed, however, the results was not satisfactory. Therefore, we made a needle type device (needle knife), recently. A cutting procedure by the needle knife has been performed at a point in the center of top of the oral elevation of major papilla. This method was successfully applied in 24 patients out of 25 patients. Indications were as follows ; impacted stones, Billroth II resected stomach, diagnostic EST and selective ERC. Complications were encountered in 12%, one perforation and two pan-creatitis, which seemed more frequent than those by the normal papillotome group (8.7%, 38 out of 436 cases), but not significant statistically. This method provides a safe precutting techinque at EST and an useful method to obtain ERC when conventional cannulation failed.
