Consistent improvement in sphincterotome orientation with manual grooming.

BACKGROUND

During ampullary cannulation with standard sphincterotomes, wire orientation is frequently to the right of 0 and can not always be rotated to the 12 o'clock ideal. It is not known if the presence of a wire guide alters a sphincterotome's orientation or if grooming in a standardized manner improves the orientation in the majority of cases.

METHODS

The intra-ampullary range of orientation of a double channel sphincterotome was prospectively evaluated before and after catheter grooming in 25 patients undergoing ERCP. The range of orientation was also measured with and without an indwelling biliary wire guide in 14 cases.

RESULTS

The maximal right orientation of the untrained sphincterotomes was 35 +/- 16 degrees; with a wire guide it was 33 +/- 22 degrees. Maximal left orientation was 17 +/- 16 degrees, wire guided it remained 19 +/- 14 degrees. Manual grooming shifted the mean maximal left orientation of the sphincterotomes to -37 +/- 28 degrees (p < 0.0001), permitting 80% of groomed sphincterotomes to achieve a 0 (12 o'clock) orientation and 100% to orient 10 degrees or less from zero.

CONCLUSIONS

The presence of the wire guide did not alter the orientation of the sphincterotome. Because manual grooming reliably improved the orientation of double-channel sphincterotomes, it should be routinely performed before their use.