Dr. Douglas Howell, M.D. - Maine Medical Center

Access in ERCP is defined as achieving deep cannulation of the ampulla of Vater through the biliary or pancreatic sphincters to begin the sequence of therapeutic intervention. Direct access involves using a single device to achieve immediate deep access without initial preliminary devices or efforts.

Figure 1 & 2

Figure 3

Difficulties facing the endoscopist in achieving direct access include the approach and orientation to the ampulla, alignment of the cannulating device to the sphincter and negotiation of the complex anatomy of the sphincter itself.

A new major innovation, which can be seen on the .025 DASH sphincterotome, is the creation of an ultra-smooth tapered rounded polished clear tip. (above). The new DomeTip addresses a major problem in gaining deep access. The anatomy of the normal sphincter of Oddi includes multiple complex papillary fronds (left). These fronds tend to “catch” any device

The DomeTip permits smooth, atraumatic, deep access by sliding over this difficult, irregular surface due to its extremely smooth, rounded profile. (figs. 1 & 2) The asymmetry of the design dramatically reduces the contact angle with the tissue, reducing friction and preventing catching, tearing, or false channels. This change can best be described as changing the “angle of insertion” for access (fig. 3).

The new DASH sphincterotome with DomeTip represents a culmination in ERCP access design, producing smooth, safe and successful deep access without requiring additional devices or efforts. Higher risk techniques, such as forceful blind guide wire insertion, pre-cutting, or needle knife unroofing, can then generally be avoided.

Maine Medical Center