The patient is screened for coagulation deficits and is given IV antibiotics perioperatively. Endoscopic sphincterotomy is carried out after ERCP has delineated the proximal part of the biliary tree with a cholangiogram.
Within the common bile duct, the sphincterotome is more accurately sited by injection of contrast media under fluoroscopic-visualisation. Ideally, about 5-8mm of wire should be touching the roof of the ampulla.
Blended current is then applied. The size of the final cut should be directly related to the size of the duct stone, but it should not be greater than 1cm. This is achieved with several consecutive cutting strokes.
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