LAUSR

SINCE THE FIRST use of endoscopic sphincterotomy (ES), ES has been well established and plays a central role in therapeutic biliary intervention. With regard to wireguided cannulation (WGC), use of a sphincterotome has been reported to have a higher selective bile duct cannulation (SBDC) success rate and lower occurrence rate of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Although Japanese randomized controlled trials did not affirm the results of previous meta-analyses, the European Society of Gastrointestinal Endoscopy guidelines place WGC as the first-line SBDC technique. The most important step of SBDC is to adjust the catheter to the bile duct axis, and the bow-up function of a sphincterotome facilitates this. Thus, sphincterotomes have an important role not only in ES but also in SBDC. Currently available sphincterotome (CleverCut3V; Olympus, Tokyo, Japan) has a coating over the proximal end of the cutting wire, which provides safe ES by protecting the duodenal mucosa and avoiding perforation in cases of overhanging folds. However, this cutting wire is sometimes too long. Therefore, bowing-up viewing the entire cutting wire for easier SBDC requires some distance between the endoscope and the orifice, and that may be too far for precise adjustment of the catheter tip (Fig. 1). To overcome this limitation, we developed a new sphincterotome (New CleverCut3V; KDVC412Q-0215, catheter tip length 2 mm, cutting wire length 15 mm; Olympus) (Fig. 2A). This sphincterotome has a shorter catheter tip and cutting wire with a coating over the proximal end of the cutting wire. Easier and compact bow-up manipulation is obtained during SBDC