Successful cannulation using a novel rotatable sphincterotome in a hepaticojejunal anastomotic stricture with a steep angle

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) is useful in patients with a hepaticojejunal anastomotic stricture [1] [2] [3]. However, biliary cannulation for such a stricture is challenging especially in cases with a steep angle, because the balloon enteroscope has no elevator function to angulate the cannulation catheter. We report a case of successful cannulation using a novel rotatable sphincterotome in a patient with a hepaticojejunal anastomotic stricture at a steep angle. A 68-year-old man who underwent hepaticojejunostomy with Roux-en-Y owing to hilar bile duct cancer was referred to our facility because of recurrent cholangitis. Magnetic resonance imaging revealed a slight biliary dilation in the intrahepatic bile duct ([Fig. 1]). Therefore, ERCP was performed using a short-type single-balloon enteroscope (SIF-H290; Olympus, Tokyo, Japan) with a working length of 152 cm and a working channel diameter of 3.2 mm [2] ([Video 1]). After reaching the hepaticojejunal anastomosis, we observed the occurrence of a hepaticojejunal anastomotic stricture ([Fig. 2]). Biliary cannulation using a conventional catheter was unsuccessful. The steep angle to the bile duct made biliary cannulation difficult. Therefore, we used a rotatable sphincterotome (Seeking Tome ZERO; MTW Endoskopie, Wesel, Germany) with a 1.8-mm tip diameter to achieve biliary cannulation ([Fig. 3]). Guidewire seeking was attempted while angulating the sphincterotome. This allowed successful biliary cannulation ([Fig. 4]). Cholangiography revealed the absence of stones. Subsequently, dilation of the stricture using a 4-mm dilation balloon catheter (REN; Kaneka, Tokyo, Japan) was performed, followed by plastic stent placement ([Fig. 5]). Compared to a previously reported rotatable sphincterotome [4] [5], this novel sphincterotome can be rotated even if there is hardly distance to the target site because it lacks a nose between the blade and the tip, which was helpful for our case. This novel rotatable sphincterotome can improve the success rate of biliary cannulation in difficult cases of hepaticojejunal anastomotic stricture. Endoscopy_UCTN_Code_TTT_1AR_2AC Article published online: 09 April 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

This publication has 5 references indexed in Scilit: