ENDOSCOPIC SPHINCTEROTOMY ASSISTED BY PERCUTANEOUS TRANSHEPATIC CHOLEDOCHAL TUBE - A PRELIMINARY-REPORT

We report a method of endoscopic retrograde sphincterotomy in patients in whom the optimal viewing of the papilla of Vater is hardly obtaine d. Percutaneous transhepatic cholangiodrainage (PTCD)-tube is placed u nder ultrasonographic guidance. PTCD-tube coming out of the papilla of Vater is observed by the endoscope and the guide wire inside the shpi ncterotome is inserted into the PTCD-tube. Sphincterotome is advanced into the common bile duct by the guidance of the guide wire and PTCD-t ube. Sphincterotomy is performed in a usual fashion. Two patients with previous history of gastrectomy underwent this procedure with success ful results. This method should be tried when usual method of EST is d ifficult and unsuccessful.