title: The impact of sphincterotome design on selective cannulation of the common bile duct.
abstract: OBJECTIVE
  There is a paucity of data regarding the impact of sphincterotome design on cannulation success.
  
  
  METHODS
  We aimed to compare the 5.5 F standard sphincterotomes of two different manufacturers (sphincterotome 1: Endo-flex 5.5F [ENDO-FLEX GmbH, Voerde, Düsseldorf, Germany] vs sphincterotome 2: Ultratome 5.5F [Boston Scientific, Spencer, IN, USA]). Adult patients undergoing their first endoscopic retrograde cholangiopancreatography were included in two study groups. The sphincterotome preloaded with a guidewire was used for selective common bile duct cannulation in each group. Precut methods were applied in failed cases without crossover. Successful biliary cannulation in 10 attempts was the primary outcome.
  
  
  RESULTS
  Baseline features and indications were similar between groups (n = 100, group I, sphincterotome 1, vs n = 100, group II, sphincterotome 2). A higher success in initial cannulation was obtained in group II compared to group I (92% vs 81%, P = 0.03). Moreover, number of cannulation attempts and time to cannulation differed. No statistical significance was noted in group I (8%) versus group II (3%) regarding pancreatitis rate. The overall cannulation success after precut in failed cases was 95% (group I) and 97% (group II).
  
  
  CONCLUSIONS
  There was a significant difference in cannulation success between the two different sphincterotome. 5.5F Ultratome with guidewire was superior to 5.5F Endo-flex sphincterotome with guidewire in initial selective cannulation of common bile duct. The results may show the importance of sphincterotome features to overcome the obstacles during cannulation such as complex intrapapillary mucosal features.
authors.affiliation: Department of Gastroenterology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Ersan
authors.initials: E
authors.lastname: Ozaslan
authors.forename: Nihal Gokbulut
authors.initials: NG
authors.lastname: Ozaslan
authors.forename: Tugrul
authors.initials: T
authors.lastname: Purnak
authors.forename: Guven
authors.initials: G
authors.lastname: Ozkaya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation*; D055815:Young Adult
keywords: ERCP; cannulation; sphincterotome