Gut Liver.  2015 Mar;9(2):231-238. 10.5009/gnl14019.

New Technique of Endoscopic Sphincterotomy with Iso-Tome(R) to Incise the Distal Papillary Roof in Patients with Choledocholiths and Choledochoduodenal Fistula

• Cho YS
• Park SH
• Jun BG
• Lee TH
• Choi HJ
• Cha SW
• Moon JH
• Cho YD
• Kim SJ

• KMID: 2380769
• DOI: http://doi.org/10.5009/gnl14019

Abstract

BACKGROUND/AIMS
It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome(R) (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome(R) for cutting the distal PR.
METHODS
Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome(R) until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse.
RESULTS
Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients.
CONCLUSIONS
The new technique of ES with the Iso-tome(R) is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths.

Keyword

Endoscopic sphincterotomy; Iso-Tome, Choledochoduodenal fistula; Distal papillary roof; Choledocholiths

MeSH Terms

Adult
Aged
Aged, 80 and over
Ampulla of Vater/surgery
Biliary Fistula/*surgery
Choledocholithiasis/*surgery
Common Bile Duct Diseases/*surgery
Duodenal Diseases/*surgery
Female
Humans
Intestinal Fistula/*surgery
Male
Middle Aged
Retrospective Studies
Sphincterotomy, Endoscopic/*instrumentation/methods
Treatment Outcome