Pre-cutting using a noseless papillotome with independent lumens for contrast material and guidewire

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.