title: A novel technique for endoscopic sphincterotomy when using a percutaneous transhepatic cholangioscope in patients with an endoscopically inaccessible papilla.
abstract: BACKGROUND
  Endoscopic sphincterotomy is difficult and sometimes impossible in patients who have undergone gastrectomy or partial gastrectomy with Billroth II reconstruction. For such patients, a novel technique was developed in which endoscopic sphincterotomy is performed via percutaneous transhepatic cholangioscopy. This report describes an initial experience with this technique.
  
  
  METHODS
  After dilation of the percutaneous fistula, a cholangioscope with a push-type sphincterotome attached was inserted into the bile duct via the fistula and then through the papilla into the duodenum. The tip of the instrument then was retroverted to obtain a frontal view of the papilla. Then, a sphincterotomy incision was extended to the proximal, orad margin of the papillary eminence.
  
  
  METHODS
  Percutaneous transhepatic biliary drainage was performed in 3 patients with obstructive jaundice and bile duct stones. In all patients, percutaneous transhepatic cholangioscopic sphincterotomy was performed successfully, without procedure-related complication. Thereafter, all stones and stone fragments cleared from the duct by spontaneous migration.
  
  
  CONCLUSIONS
  Endoscopic sphincterotomy via percutaneous transhepatic cholangioscopy potentially is an innovative technique for endoscopic sphincterotomy in patients with an endoscopically inaccessible papilla.
authors.affiliation: Fourth Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shinohara
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takeda
authors.forename: Kazuto
authors.initials: K
authors.lastname: Nakamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D042882:Gallstones / Q000150:complications / Q000628:therapy*; D005743:Gastrectomy; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D016717:Sphincterotomy, Endoscopic / Q000379:methods*