title: Pre-cutting using a noseless papillotome with independent lumens for contrast material and guidewire.
abstract: BACKGROUND
  The technical success of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) depends on selective cannulation into the bile duct. We have developed a new type of precut papillotome for selective cannulation.
  
  
  METHODS
  The newly developed precut papillotome has been equipped not only with a lumen for contrast materials but also with an independent lumen for the guidewire. The operation of the guidewire and the injection of contrast material can be carried out simultaneously. The precut papillotome has a 20-mm-long knife and no leading tip. Half the proximal side of the knife is coated for insulation.
  
  
  RESULTS
  Selective biliary cannulation failed in 26 of 293 patients (8.9%) in whom therapeutic ERCP was attempted. We applied the precut papillotome to these 26 patients and selective cannulation was successful in 24 of 26 patients (success rate: 92.3%). No major complications occurred, although mild bleeding, which did not require endoscopic hemostasis or blood transfusion, was observed only in one patient.
  
  
  CONCLUSIONS
  Although further studies with a large number of patients are needed to evaluate the efficacy of the papillotome, this papillotome may contribute to increase the safety and the success rate of precutting.
authors.affiliation: Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
authors.forename: Naohito
authors.initials: N
authors.lastname: Uchida
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsutsui
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamada
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Ogawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Fukuma
authors.forename: Toru
authors.initials: T
authors.lastname: Ezaki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Aritomo
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ono
authors.forename: Asahiro
authors.initials: A
authors.lastname: Morishita
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
authors.forename: Seishiro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakatsu
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kuriyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation*; D016896:Treatment Outcome