Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

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.

Características morfológicas de la papila duodenal y su relación con complicaciones poscolangiopancreatografía retrógrada endoscópica en un hospital de Perú

“…Un estudio retrospectivo publicado en China en 2020 revela que las papilas tipo 2 y 3 requieren más tiempo para la canulación y tienen una tasa más alta de canulación fallida (12 % y 11,1 %) con respecto a las papilas 1 y 4 (1,7 % y 6,25 %) (13) , a diferencia de nuestros resultados, que muestran que los tipos de papila que requirieron más tiempo de aunque no encontramos asociación entre el tipo de papila y la canulación difícil. Por su parte, los tiempos promedio de canulación mostrados en nuestro estudio fueron mayores, sobre todo para el tipo 4.…”

“…La pancreatitis fue el evento adverso más frecuente, con una tasa más alta en el tipo 2 (9,09 %). Este hallazgo fue similar a lo encontrado por Chen y colaboradores, en cuyo estudio la papila de tipo 2 tuvo el mayor porcentaje de pancreatitis pos-CPRE (20 % frente a 6,78 % del tipo 1; 1,59 % del tipo 3 y 6,25 % del tipo 4; p = 0,020) (13) . Haraldsson y colaboradores en 2019 también informaron una mayor tasa de pancreatitis para la papila de tipo 2 (9,4 %), pero sin diferencias significativas con respecto a los otros tipos de papilas (9) .…”

“…En nuestro estudio no observamos colangitis aguda como complicación, evento adverso que sí fue reportado en otros estudios con tasas entre 0,6 % y 1,75 % (9,13,15) . Encontramos una asociación estadísticamente significativa entre el tipo de papila y realización de precorte tipo fistulotomía como técnica de rescate en caso de canulación convencional fallida, y fue más frecuente en los tipos 4 (33,33 %) y 3 (30 %).…”

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones

“…Therefore, identifying factors that predict difficult biliary cannulation during ERCP may help reduce the incidence of PEP in patients with CBDS. Although previous reports have revealed that malignant biliary strictures are a risk factor for difficult cannulation [ 21 , 22 ], only a few studies have focused on factors predicting difficult biliary cannulation in patients with CBDS.…”

Safety of Nonagenarians Receiving Therapeutic ERCP, Single Center Experience

“…Thus, nonagenarians require more ERCP procedures to eliminate bile duct stones [ 22 ]. In addition, the higher proportion of tumors in elderly patients, especially ampullary carcinoma, resulted in difficult cannulation [ 23 ], which was known as a factor for post-ERCP complications [ 21 ]. Age and multiple comorbidities are also associated with increased odds of inpatient mortality in patients undergoing ERCP [ 16 ].…”