Dr. Nageshwar Reddy
MD, DM, FAMS, FRCP
Chief Gastroenterologist

The introduction of DASH Dome-Tip – sphincterotome (COOK® Endoscopy, Winston Salem, NC, USA) has eased another step for the success of therapeutic Endoscopic Retrograde Cholangio-pancreatography procedure. DASH DomeTip sphincterotome effectively combines the utility of regular sphincterotome for selective cannulation with safety of all ball tip catheter. The pre-curved tip allows selective cannulation of biliary system or pancreatic duct. The smooth dome at the tip, similar to the "ball" of ball tip cannula, prevents any local trauma to the papilla – a major advantage over other sphincterotomes.

Presently, the DASH DomeTip is available with or without a wire guide in the 0.025 inch DASH product line. The wire guides of 0.021 inch, 0.025 inch and 0.035 inch gauge Tracer Metro Direct are available in 260 cm and 480 cm length. In situations of tight malignant strictures, the accompanying Tracer Metro Direct wire guide negotiates these narrow passages quite smoothly for access. The DASH DomeTip is then pushed up and beyond the stricture/stone with the access being maintained by simply locking the wire in place at the hub. Selective chlangiogram or pancreatogram is obtained after deep cannulation over wire guide without any exchange using the integrated hub for the injection and enhanced wire control, and thus saving crucial procedure time of sedated/anaesthetized patients. The accompanying sphincterotome with markings has the usual advantage of judging the depth of the cut.

After introduction of DASH DomeTip in our ERCP unit at Asian Institute of Gastroenterology, Hyderabad, the frequency of accidental tissue injection (unlike those with standard/regular or tapered tip cannula) has significantly reduced, even among the training fellows. Also the inflammation and edema at papilla during the procedure is much less, leading to the early observation of reduced frequency of post-ERCP pancreatitis.

Asian Institute of Gastroenterology
6-3-661, Somajiguda, Hyderabad –
500 082, INDIA
Ph: 91-40-23378888, 22310675, 55510072/73.
Fax: 91-40-23324255
Email: aigindia@yahoo.co.in

Graph of Compressive Load vs. Extension for Lubricated Catheter Tips Entering Sphincter Model. Independent laboratory - data on file.