ENDOSCOPIC FISTULOTOMY - THE SUPRAPAPILLARY PUNCH - A METHOD OF ACCESS TO THE BILE-DUCT DURING ERCP

Endoscopic retrograde cholangiopancreatography (ECRP) is established a s the method of choice to investigate the biliary tree when obstructio n is suspected. On rare occasions, the papilla cannot be entered becau se of anatomical or pathological abnormalities. This report describes endoscopic fistulotomy or the suprapapillary punch that has been carri ed out at the Foothills Hospital in Calgary, Alberta, on 30 of 623 pat ients referred for ERCP for conditions causing obstruction of the comm on bile duct or suspected obstruction of the common bile duct. The fol lowing communication also describes the method of suprapapillary punch or endoscopic fistulotomy. Results alive been excellent with only one complication, a minor attack of pancreatitis after the procedure. In summary, the suprapapillary punch or fistulotomy is a safe and useful method for entering the common bile duct when access by the usual meth od is impossible.