Rotatable sphincterotome facilitates bile duct cannulation in patients with altered ampullary anatomy.

In patients who have undergone prior Billroth-II (B-II) anastomosis, endoscopic retrograde cholangiopancreatography (ERCP) is challenging due to altered duodenal anatomy, which requires use of customized sphincterotomes. We report the use of a standard rotat-able sphincterotome for successful cannulation in 5 patients with prior B-II gastrojejunostomy and 1 patient with choledochoduodenostomy. In our experience, cannulation and endoscopic intervention were successfully accomplished in all patients without any complications.