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Sphincterotomy, also known as papillotomy, is usually performed to incise the orifice of the papilla of Vater, giving improved access to the bile and pancreatic ducts. The enlarged opening of the papilla makes not only the removal of gallstones easier, but also the insertion of stents to drain stenoses.
Two types of sphincterotomy may be performed. The papilla can be incised with a pre-curved sphincterotome following selective duct cannulation. However, cannulation may not be possible in some patients due to minor or constricted papillae. In these patients, access to the common bile duct may be gained using the pre-cut sphincterotomy technique. In this case, a needle knife is used, incising the papilla from the outside. This technique may also be used to free stones that have become impacted at the opening of the papilla. Sphincterotomes and needle-knives cut the papilla using high-radio frequency electrosurgical current.
Sphincterotomy is achieved with Olympus’ guidewire compatible 2- or 3-lumen pre-curved sphincterotomes. The CleverCutV series comes with a special coating on the proximal end of the cutting wire to minimise damage to surrounding tissue and reduce the risk of electrical contact between the cutting wire and the endoscope. For pre-cutting the papilla, Olympus offers a range of needle knives. These devices come as standard needle knives or with CleverCut coating for a controlled cutting depth.