Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study
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RESEARCH ARTICLE
Open Access
Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study Po-Han Chen1, Chun-Fang Tung1,2, Yen-Chung Peng1,2, Hong-Zen Yeh1,2, Chi-Sen Chang1 and Chia-Chang Chen1*
Abstract Background: 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. Methods: 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. Results: 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. Conclusion: 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. Keywords: ERCP, Greater duodenal papilla, Endoscopic biliary Sphincterotomy, Endoscopy, gastrointestinal, Biliary tract surgical procedures
Background Selective biliary cannulation (SBC) during endoscopic retrograde cholangiopancreatography (ERCP) is required in all therapeutic biliary procedures and is technically challenging. However, SBC can fail in up to 20% of cases even when performed by expert biliary endoscopists [1].
* Correspondence: [email protected] 1 Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung 40705, Taiwan Full list of author information is available at the end of the article
Multiple attempts at SBC increase the risk of post-ERCP pancreatitis (PEP), and other related complications [2]. The rates of complications related to attempting SBC range between 4 and 30% in the literature [2, 3]. Multiple factors are involved in biliary cannulation failure. For example, duodenal positioning, adequate visualization of the papilla, size of the papilla, variant patient anatomy, and sur
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