Ryosuke Tonozuka, MD, from the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan shares this video case “Endoscopic sphincterotomy using an isolated-tip needle-knife papillotome after Billroth II gastrectomy.”

A needle knife papillotome (NKP) has been used instead of a standard sphincterotome knife for difficult endoscopic sphincterotomy (ES) in patients with a surgically altered anatomy. However, NKP may increase the risk of post-procedure pancreatitis because its tip is more directly in contact with the pancreatic duct, causing electric damage. The newly developed papillotome isolated-tip needle knife papillotome (ITNKP) is a modified NKP that has a round tip made of sapphire to prevent electrical damage. This video describes ES using ITNKP for choledocholithiasis in a patient with a Billroth-Ⅱ gastrectomy.
Figure 1. A, External view of an isolated-tip needle-knife papillotome (ITNKP). B, Endoscopic view of endoscopic sphincterotomy using an ITNKP.

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