Post written by Hideyuki Shiomi, PhD, MD, from the Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

The double-guidewire technique (DGT) is considered as a promising salvage approach in difficult biliary cannulation cases. Nevertheless, with the interference of the pancreatic duct guidewire (P-GW) against cannulation devices, this technique sometimes becomes challenging with difficulty aligning the axis of the device with the biliary direction. We have developed a novel double-lumen sphincterotome (MagicTome; PIOLAX, Tokyo, Japan) to solve this problem. Herein, we present 2 successful cases using DGT with this unique sphincterotome for difficult biliary cannulation.

MagicTome is a double-lumen sphincterotome with independent ports for the P-GW and bile duct guidewire (B-GW), both measuring 0.025 inch in diameter. Compared to conventional sphincterotomes, MagicTome affords extra benefits facilitating the DGT in problematic cases. This sphincterotome is designed so that the distal lumen is aligned with the bile duct while adapting the P-GW by the proximal lumen. This design not only avoids the impedance of the P-GW against cannulation devices, but also uses it as a stabilizing tool for the papilla allowing the sphincterotome’s distal tip to navigate freely to comply along the biliary axis, maintaining easier cannulation of bile duct. Additionally, it allows simultaneous injection of contrast allowing mapping of biliary tract with a subsequent safe guidewire advancement.

This novel sphincterotome, compared to conventional ERCP catheter and sphincterotome, has facilitated the DGT with an easier approach for difficult biliary cannulation. The rate of biliary cannulation may be improved. This sphincterotome can be used as an initial biliary cannulation device.

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