EFFICACY OF MODIFIED-TYPED PRE-CUTTING PAPILLOTOME WITH INDEPENDENT LUMENS FAR GUIDE SIRES

Abstract

Pre-cutting improves the success rate of cannu.lation into the comrnon bile duct. However, this technique is not prevalent in Japan because of the postoperative complications such asbleeding, perforation and acute pancreatitis. We have reported the efficacy of the new typedpre-Dotting papillotome which was equipped not only with a lumen for contrast materials loutalso with an independent lumen for guide wires. This papillotorne has an advantage that theoperation of the guide wire and the injection of contrast materials can be carried out simultaneously. We made a few modifications to the previously reported pre-cutting papillotome. In thepresent study we estimated the modified pre-cutting papillotome that has a 20mm knife inlength(half of the proximal side being Clever cut coating)and does not have a leading tip. Weapplied the papilletome in 5 patients with commen bile duct stones and a patient with pancreatichead cancer in whom selective bile duct cannulation had failed. Selective cannulations into thebile ducts were succeeded in 50f 6 patients on the initial attempt of pre-cutting(success rate:83.3%)withou.t any complications. There was no significant difference in success rate of pre-cutting between two types of the papillotomes. However, the modified papillotome made notonly pre-cutting procedure easier but also EST fellewing pre-cutting easier. Although further studies with a large number of patients are needed to evaluate the efficacyof the papillotome, this papilleteme may help to increase the safety and the success rate of precuttlng.