Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth II gastrectomy

Figure 1 Guide wire using sphincterotomy by triple lumen needle knife. A: A triple lumen needle knife was introduced into the major papilla over the guidewire and the tip of needle was then controlled with 2-3 mm length; B: Sphincterotomy was performed along the guide wire as a guidance mark directed in the 4-5 o’clock direction with sophisticated maneuver of needle knife and endoscopy; C: Sphincterotomy to the upper margin of the papillary roof was performed; D: A stone was removed by basket without balloon dilation or mechanical lithotripsy.