Endoscopic fistulo-sphincterotomy: an alternative method of sphincterotomy using a new sphincterotome

A new method of endoscopic sphincterotomy (ES) is described when selective cannulation of the common bile duct (CBD) is not possible and a prominent intraduodenal segment of the CBD is endoscopically recognized. A straight retractable sphincterotome was specifically designed to produce an artificial choledochoduodenal fistula which was subsequently extended to allow passage or extraction of CBD stones. This method was successfully applied in 15 patients with choledocholithiasis without any complications. All patients have remained symptom free on up to 2 1/2 years of follow up. Endoscopic fistulo-sphincterotomy provides as safe alternative method of ES when currently available techniques have failed.