Needle-knife sphincterotomes are usually used during endoscopic retrograde cholangiopancreatography
(ERCP) when standard cannulation methods with a cannula alone or even with a standard
sphincterotome have failed, but as yet the combination of a standard sphincterotome
and a needle-knife sphincterotome has not been used simultaneously. We present a novel
sphincterotome, named the “dualtome,” that has the features and abilities of both
standard and needle-knife sphincterotomes.
To create a dualtome, we first need a needle-knife wire that has a handle for electrical
connections. The cutting wire of a standard sphincterotome is disconnected with a
cut at the distal tip of the sphincterotome and the handle of the standard sphincterotome
is then separated by cutting the proximal plastic sheath of the sphincterotome while
preserving the cutting string. The string is taken out of this standard sphincterotome
to be used as the cutting wire for the needle-knife sphincterotome ([Fig. 1]). The needle-knife sphincterotome is created by gently loading the string into the
injection channel of another new standard sphincterotome. The handle connected to
the string is fixed to the orifice of the injection channel and the distal tip of
the string is then cut and calibrated to a length of 5 mm, which is the same as a
standard needle-knife while in cutting position. Once the guidewire has been loaded
into its channel, the dualtome is ready to be used for both needle-knife and standard
sphincterotomies ([Fig. 2]).
Fig. 1 Photographs showing how the cutting wire of the dualtome is created with a string
that is disconnected from a standard sphincterotome.
Fig. 2 The dualtome has two separate handles; the string has been loaded into the injection
channel and its tip has been calibrated to a length of 5 mm; the guidewire has been
loaded into its own channel.
The string can be easily removed to use the injection channel for other purposes after
cannulation or needle-knife procedures have been completed. The dualtome has two separate
handles for each of the sphincterotomy procedures and this makes the electrical connections
and the method easier and more feasible. Dualtome is applied for selective biliary
cannulation as a demonstration ([Video 1]).
A dualtome is used for selective biliary cannulation with the fistulotomy method
in a patient with a biliary stone.
The dualtome is a needle-knife sphincterotome that has the bowing ability of a standard
sphincterotome. The bowing maneuver enhances the cutting ability of the dualtome,
making it safer and easier to use when compared with a needle-knife sphincterotome.
In addition, the dualtome still has the features of a standard sphincterotome, meaning
it is possible to easily change between the different types of sphincterotome or use
both simultaneously without wasting time and effort during any ERCP procedures. This
report also describes a novel method for cannulation using the features of both standard
and needle-knife sphincterotomes, as in the dualtome. Manufacture of a dualtome that
worked independently of the injection channel would make it widely applicable and
useful in ERCP procedures.
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