2005 Volume 47 Issue 8 Pages 1556-1567
The key to minimizing papillary hemorrhage is to perform the sphincterotomy in the correct direction, by using suitable electro-surgical current and by maintaining reliable control in the degree of coagulation surrounding the incision line. The cutting direction should be maintained in the 11 to 12-o'clock range with the current of choice as pure cuttig. To control the width of the coagulated area surrounding the incision line, the cut should be extended in a very gradual manner while applying short bursts of current, cutting only 1-2mm at a time. With the first 3 to 5 mm of the incision, however, care should be taken to avoid excessive coagulation of tissue as this causes edema, which increases the risk of pancreatitis. Another serious problem related to papillary hemorrhage is a sudden zipper cut. The sphincterotome should be bent to establish contact between the cutting wire and the papillary roof. To prevent a sudden zipper cut, a responsive beginning of incision should be initiated without excessive bending of the sphineterotome. To achieve a quick start of sphincterotomy, the leak of current from the cutting wire to the scope should initially be avoided. Next, the contact area between the cutting wire and the papillary roof should be as minimal as possible. Finally, counter-traction between the cutting wire and the papillary roof should be maintained.
