Conclusions

A rotatable sphincterotome may serve as a useful rescue tool for technically difficult colonic SEMS placement when conventional catheters fail to achieve guidewire passage through an eccentrically oriented or acutely angulated malignant stricture. Its capacity to reorient the bending plane circumferentially provides an additional degree of freedom for coaxial tip alignment that single-plane devices cannot. This appears to be the first reported use of a rotatable sphincterotome for colonic SEMS placement; sphincterotome-assisted guidewire insertion itself is an established technique. Further prospective studies are needed to define the role of this device within the algorithmic approach to difficult colonic stenting and to determine whether its technical advantage reduces procedural failure and complication rates.