Technical commentary on endoscopic sphincterotomy

• Published in: Tando Vol. 19; no. 4; pp. 448 - 457
• Main Authors: INOMATA, Msaaki, TERUI, Torahiko, ENDO, Masaki
• Format: Journal Article
• Language: Japanese
• Published: Japan Biliary Association 2005
• Subjects: complication; endoscopic sphincterotomy; 偶発症; 内視鏡的十二指腸乳頭括約筋切開術
• ISSN: 0914-0077; 1883-6879
• DOI: 10.11210/tando1987.19.4_448

The key to minimizing complications 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 cutting. 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 1-2 mm 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 and duodenal perforation is a sudden zipper cut. To prevent a sudden zipper cut, a responsive beginning of incision should be initiated without excessive bending of the sphincterotome. To achieve a quick start of incision, 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.