For patients in the EST group, a complete sphincterotomy was performed with a pull-type sphincterotome
and the sphincter was divided up to the transverse duodenal fold.
Second, the endoscope was inserted by the endoscopist from the mouth to the duodenum, the guidewire was pulled out of the mouth, the sphincterotome
was inserted, and an intraoperative sphincterotomy was done, followed by stone removal by a balloon, and the endoscope was removed.
After access to the MPD, TPS was performed with the traction sphincterotome
directing towards 11 o'clock, and CBD orifice is usually located left to the pancreatic duct after TPS (Figures 1 and 2).
The CBD was selectively cannulated using a sphincterotome
and a 0.035-inch hydrophilic guidewire (Boston Scientific, Natick, MA, USA).
The cannulation was successfully performed using sphincterotome
(Clever Cut 3V, Olympus, Tokyo, Japan).
When the main pancreatic duct leak was observed, sphincterotomy was performed with an Olympus FlowCut KD-301Q0725 sphincterotome
and pancreatic stent was placed (passive transpapillary drainage) to bridge the leak--5Fr, 7Fr, 8.5Fr, or 10Fr (Geenen, Zimmon Pancreatic Stent, Wilson-Cook Medical Inc.
Cannulation of the bile duct was attempted using a sphincterotome
(Olympus, Tokyo, Japan) with a 0.035-inch guide wire (Boston Scientific, Natick, MA, USA).
Under the endoscopic monitoring, a sphincterotome
loaded with guide wire was introduced through endoscope to approach the opened basket; the guide wire was advanced until its hydrophilic tip was trapped into basket (Figure 3).
The instructors mainly gave advice to the beginners on how to manipulate the scope, sphincterotome
, and needle knife sphincterotome