sphincterotome

A sphincterotome is a specialized endoscopic instrument used during endoscopic retrograde cholangiopancreatography (ERCP) to perform biliary or pancreatic sphincterotomy. It consists of a flexible catheter with a short, often stiff distal segment that carries a cutting wire. The wire can be exposed for tissue cutting and is connected to an electrosurgical unit to deliver controlled current. Many models include a lumen to accommodate a guidewire, facilitating duct access and stability during the procedure.

Design and variants vary, with pull-type and push-type configurations commonly available. The device is chosen to allow precise directional control of the incision and to accommodate patient anatomy and the planned extent of the cut. The cutting wire is positioned across the sphincter to achieve an incision that enlarges the ductal orifice for stone extraction, duct cannulation, or stent placement.

Procedure and use: after biliary or pancreatic duct cannulation and guidewire placement, the sphincterotome is advanced across the sphincter of Oddi. The wire is oriented to direct the cut, and controlled electrosurgical current is applied to incise the sphincter. The length of the cut and energy settings are adjusted to achieve the desired opening while minimizing trauma.

Risks and considerations include post-ERCP pancreatitis, bleeding, perforation, and infection. Proper technique, patient selection, and operator experience influence outcomes. The sphincterotome remains a standard tool for enabling access to the bile and pancreatic ducts during ERCP.