CLINICAL EVALUATION OF ENDOSCOPIC SPHINCTEROTOMY WITH A BIPOLAR SPHINCTEROTOME

Abstract

Endoscopic sphincterotomy (EST) using a newly developed bipolar sphincterotome (Everest Medical Co) was performed in 14 patients with various bile duct diseases for diagnosis and treatment of these diseases. The bipolar sphincterotome is designed as consisting of two electrodes : a cutting wire and the return coil electrode encircling the catheter. Two types of electrosurgical generator (Olympus UES and Evelest Medical K2 -8700) were used in this study. Sphincterotomy was performed successfully in 13 of 14 cases. One failure was due to a weak power of incision at the setting of an electrosurgical generator. In 13 cases with successful sphincterotomy, endoscopic transpapillary treat-ment and/or diagnosis were all completed by these procedures. In these series, minimum bleeding was seen in 2 cases and perforation for which no surgical therapy was required, was encountered in 1 case. Bipolar EST is performed by passing radio frequency (RF) current flows from the cutting wire through the tissue to the return electrode. The localized RF current reduces systemic complications especially for the patient with a pacemaker and eliminates the need for a distant return electrode (grounding pad). Therefore, the bipolar sphincterotome can be used easily and safely. At present, however, this bipolar sphincterotome is inferior to the monopolar sphincterotome in the manipulation and the durability. Further refinements of the instruments are recommended for better and wider use of the technique.