A novel technique for endoscopic sphincterotomy when using a percutaneous transhepatic cholangioscope in patients with an endoscopically inaccessible papilla.
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.
Itoi
Takao
T
Fourth Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
Shinohara
Yasushi
Y
Takeda
Kazuya
K
Nakamura
Kazuto
K
Sofuni
Atsushi
A
Itokawa
Fumihide
F
Moriyasu
Fuminori
F
Tsuchida
Akihiko
A
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*