A new papillotome for cannulation, precut or conventional papillotomy

A new papillotome was designed to overcome certain drawbacks of the needle- knife, that is most commonly used for precut sphincterotomies. The intentio n was to develop an instrument at least as good as the needle-knife or the Erlangen-type precut papillotome for precut procedures. In addition, it had to be suitable for direct cannulation of die biliary or pancreatic duct. Patients nod methods: According to a prospective protocol 54 patients in wh om a papillotomy was indicated were examined with the new instrument. The p rotocol allowed three futile attempts to cannulate or two inadvertant cannu lations of the pancreatic duct with a standard cannula and hydrophilic guid e wire before a precut was performed. ;The new baby-papillotome has a diame ter of only 1 mm and a short 10 mm cuttings wire. Similar to a guide wire i t is introduced via a 6F- or 7F-introducer catheter. Results: Cannulation of the desired duct (the bile duct in 48 patients, the pancreatic duct in five patients, Billroth II anatomy in three patients) w as successful within one session in 98% (53/54). In one patient, the bile d uct was successfully cannulated in a second session using the baby-papillot ome, resulting in an overall success rate of 100%. Primary cannulation usin g the new papillotome without pre-cut was obtained in 24% (13/54). Complica tions were mild pancreatitis in one patient and nonsignificant bleeding in three (immediate endoscopic hemostasis in all: no transfusions, no drop of hematocrit). There were no serious complication. Conclusion: The new baby-papillotome is suitable for precut rut as well as for primary cannulation. In this first series, the desired duct was cannula ted in 98% within the first session with a low complication rate. Further s tudies of the new instrument seem desirable.