title: New technique of endoscopic sphincterotomy with iso-tome® to incise the distal papillary roof in patients with choledocholiths and choledochoduodenal fistula.
abstract: OBJECTIVE
  It is sometimes difficult to incise the dis-tal papillary roof (PR) completely in patients with choledocho-liths and choledochoduodenal fistula (CDF). The Iso-Tome® (MTW-Endoskopie W. Haag KG), which is helpful in prevent-ing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome® for cutting the distal PR.
  
  
  METHODS
  Between May 2003 and July 2012, 35 pa-tients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome® until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse.
  
  
  RESULTS
  Spontaneous or artificial CDF occurred in four and 31 pa-tients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapap-illary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients.
  
  
  CONCLUSIONS
  The new technique of ES with the Iso-tome® is feasible and useful for effectively incising the distal PR in patients with CDF and choledocho-liths. (Gut Liver, 2015;9231-238).
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Young Sin
authors.initials: YS
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Baek Gyu
authors.initials: BG
authors.lastname: Jun
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Cha
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Sun Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D001658:Biliary Fistula / Q000601:surgery*; D042883:Choledocholithiasis / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000601:surgery*; D004378:Duodenal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Choledocholiths; Distal papillary roof; Endoscopic sphincterotomy; Iso-Tome, Choledo-choduodenal fistula