ERCP biliary cannulation difficulty as a function of papillary subtypes: a tale of shapes and Shar-Pei dogs

Adler, Douglas G.

doi:10.1016/j.gie.2019.07.030

Cited by 18 publications

(12 citation statements)

References 9 publications

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“…Despite its multicenter validation and systematic description of morphology for the four different types of papilla, the classification scheme was described as limited, on one hand due to the non-inclusion of some other relatively frequent papilla types and, on the other hand, because of the lack of evidence regarding the risk that such anatomical variations pose on the post-ERCP occurrence of adverse events [12]. Therefore, the expanded systematic arrangement in our study aimed to cover some other papillary aspects like the small and retracted papillae or the large, hooded papillae with multiple folds over the orifice.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the essential role of deep duct cannulation in the procedural safety and success, to date there is only limited research concerning the impact of papillary morphology on bile duct cannulation [10][11][12]. On the other hand, any experienced ERCP endoscopist can differentiate multiple morphologies of the major papilla and their impact on choosing different bile duct cannulation strategies [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study

Bălan

Arya

Cătinean

et al. 2020

JCM

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered. Results: Morphology of the papilla influences both overall complication rates (95%CI, p = 0.0066) and post-ERCP pancreatitis rates (95%CI, p = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, p = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, p = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study

Bălan

Arya

Cătinean

et al. 2020

JCM

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“…In biliary endoscopy, certain features of the papilla itself could influence cannulation difficulty. However, there are limited data on the association between papilla morphology and cannulation outcomes [5]. In 2017, Haraldsson et al proposed four types of papilla.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…In biliary endoscopy certain features of the papilla itself could in uence cannulation di culty. However, there are limited data on the association between papilla morphology and cannulation outcomes [5] . In 2017, Haraldsson et al proposed four types of papilla.…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Tung

Peng

et al. 2020

Preprint

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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.Method 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.

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ERCP biliary cannulation difficulty as a function of papillary subtypes: a tale of shapes and Shar-Pei dogs

Cited by 18 publications

References 9 publications

Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study

Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study

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

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

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