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- Title
Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study.
- Authors
Chen, Po-Han; Tung, Chun-Fang; Peng, Yen-Chung; Yeh, Hong-Zen; Chang, Chi-Sen; Chen, Chia-Chang
- Abstract
<bold>Background: </bold>We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.<bold>Methods: </bold>A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson's classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.<bold>Results: </bold>A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.<bold>Conclusion: </bold>Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.
- Subjects
ENDOSCOPIC retrograde cholangiopancreatography; RETROSPECTIVE studies; DUODENUM; PANCREATITIS; ENDOSCOPIC gastrointestinal surgery; CATHETERIZATION
- Publication
BMC Gastroenterology, 2020, Vol 20, Issue 1, p1
- ISSN
1471-230X
- Publication type
journal article
- DOI
10.1186/s12876-020-01455-0