The impact of sphincterotome design on selective cannulation of the common bile duct


  • Conflict of interest: Drs Ersan Ozaslan, Nihal G. Ozaslan, Tugrul Purnak, and Guven Ozkaya have no conflicts of interest or financial ties to disclose.
  • Sources of funding, grant support, financial disclosure: None to disclose.


Dr Ersan Ozaslan, Department of Gastroenterology, Ankara Numune Education and Research Hospital, Çukurambar Mah. 1429. cad. 24/2, Çankaya, Ankara, Turkey. Email:


Background and Aim

There is a paucity of data regarding the impact of sphincterotome design on cannulation success.


We aimed to compare the 5.5 F standard sphincterotomes of two different manufacturers (sphincterotome 1: Endo-flex 5.5F [ENDO-FLEX GmbH, Voerde, Düsseldorf, Germany] vs sphincterotome 2: Ultratome 5.5F [Boston Scientific, Spencer, IN, USA]). Adult patients undergoing their first endoscopic retrograde cholangiopancreatography were included in two study groups. The sphincterotome preloaded with a guidewire was used for selective common bile duct cannulation in each group. Precut methods were applied in failed cases without crossover. Successful biliary cannulation in 10 attempts was the primary outcome.


Baseline features and indications were similar between groups (n = 100, group I, sphincterotome 1, vs n = 100, group II, sphincterotome 2). A higher success in initial cannulation was obtained in group II compared to group I (92% vs 81%, P = 0.03). Moreover, number of cannulation attempts and time to cannulation differed. No statistical significance was noted in group I (8%) versus group II (3%) regarding pancreatitis rate. The overall cannulation success after precut in failed cases was 95% (group I) and 97% (group II).


There was a significant difference in cannulation success between the two different sphincterotome. 5.5F Ultratome with guidewire was superior to 5.5F Endo-flex sphincterotome with guidewire in initial selective cannulation of common bile duct. The results may show the importance of sphincterotome features to overcome the obstacles during cannulation such as complex intrapapillary mucosal features.