Digestive Diseases and Sciences

, Volume 59, Issue 12, pp 3078–3084 | Cite as

The Comparison of Two Different 5.5 Fr Sphincterotomes for Selective Cannulation of the Common Bile Duct: A Prospective, Randomized Study

  • Ersan Ozaslan
  • Tugrul Purnak
  • Cumali Efe
  • Nihal Gokbulut Ozaslan
  • Mustafa Cengiz
Original Article


Background and Aim

There are scarce data regarding the impact of sphincterotome design on cannulation success. We aimed to compare two different 5.5 Fr standard sphincterotomes to determine initial cannulation success.


Adult patients with naive papillae were enrolled in a prospective, randomized, crossover study. Two different 5.5 Fr sphincterotomes preloaded with guidewire (GW) were used in two groups with 140 patients included per group. A total of five papillary attempts and two pancreatic channel entries were allowed as maximum targets. In a case of more than two pancreatic entries, a double GW technique was attempted before crossover. If choledochal cannulation was not achieved within ten papillary attempts or more than four pancreatic entries despite crossover, access papillotomy was performed. Successful biliary cannulation was the primary outcome. Secondary outcomes were incidence of early complications and overall cannulation success.


Higher initial cannulation success was achieved in group I compared with group II (88.5 vs. 77.1 %, p = 0.011). The crossover and double GW techniques reduced the need for precut from 11.7 to 5.3 %. The overall cannulation success including precut for failed cases was 99.2 % (group I) and 98.5 % (group II). Sphincterotome type, presence of crossover, and number of cannulation attempts were predictors of successful cannulation in multivariate analysis.


There was a significant difference in cannulation success between two different 5.5 Fr sphincterotomes. The cannulation success was mainly governed by sphincterotome design which serves a proper spatial orientation during the procedure. The combined use of crossover and double GW techniques may substantially decrease precut necessity.


ERCP Cannulation Sphincterotome Biliary 



Endoscopic retrograde cholangio pancreatography


Common bile duct


Post-ERCP pancreatitis




Complete blood count


Computed tomography


Double guidewire


Pancreatic duct


Cannula, catheter





We would like to express our special thanks of gratitude to Prof. Todd Baron from Mayo Clinic for reviewing of our manuscript.

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ersan Ozaslan
    • 1
  • Tugrul Purnak
    • 1
  • Cumali Efe
    • 2
  • Nihal Gokbulut Ozaslan
    • 3
  • Mustafa Cengiz
    • 4
  1. 1.Department of GastroenterologyAnkara Numune Education and Research HospitalÇankayaTurkey
  2. 2.Department of Gastroenterology, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  3. 3.Department of Anesthesia, Faculty of MedicineGazi UniversityAnkaraTurkey
  4. 4.Department of Gastroenterology, Faculty of MedicineGazi UniversityAnkaraTurkey

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