Functional anatomy of the papilla Vateri

Paulsen, Friedrich; Bobka, Timm; Tsokos, Michael; Fölsch, Ulrich R.; Tillmann, B.

doi:10.1007/s00464-001-9073-y

Cited by 14 publications

(5 citation statements)

References 8 publications

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“…All endoscopists carrying out endoscopic retrograde cholangio‐pancreaticography (ERCP) recognize the obvious differences in the appearance of the papilla of Vater. There are several descriptions of the papilla of Vater, anatomically, 16–18 radiologically 19 , 20 and histologically, 21 but none of these contain any structured classification of the macroscopic appearance of the papilla of Vater as perceived during the endoscopic examination. Moreover, there is a widespread opinion that the macroscopic appearance might well co‐vary with the cannulation complexity, 22 , 23 complication rates 24 and also with other factors of relevance for the management of individual patients 25 .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

et al. 2017

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Background: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. Objective: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. Methods: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, 'classic appearance'; (b) Type 2: small papilla, often flat, with a diameter 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists. Results: Interobserver agreement was substantial (k ¼ 0.62, 95% confidence interval (CI) 0.58-0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (k ¼ 0.66, 95% CI 0.59-0.72). Conclusion: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter-and intraobserver agreement and now the clinical relevance of the four different papilla types awaits to be determined.

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Section: Introductionmentioning

confidence: 99%

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

et al. 2017

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“…The incidence of unintentional p-GW was comparable to that of 39.0% in a well-designed multicenter prospective study 19 . Anatomically, the distal bile duct and main pancreatic duct merge to form the "common channel" with a 3.0- to 8.0-mm length in most patients (68.0%-86.0%) 3 . Therefore, when the mucosal folds entrap the guidewire top before this merging into the sigmoidal common channel, the guidewire is potentially flicked off into the pancreatic duct when creating the looped feature.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the papilla of Vater, WGBC can be achieved in two steps: 1) selection of the biliary narrow distal segment (NDS) at the biliary-pancreatic bifurcation; and 2) advancement of the guidewire through the NDS. The NDS, which includes dense inner mucosal folds as check valves, may have a reverse-S or N shape 3 4 5 . Although previous studies have focused on the characteristics of the guidewire used for WGBC, a dedicated guidewire has not been established 6 7 8 9 .…”

Section: Introductionmentioning

confidence: 99%

A novel concept of passive loop-forming wire-guided biliary cannulation using an ultra-deep angled tip guidewire (with video)

Ban,

Kubota,

Takahama

et al. 2023

Endosc Int Open

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Background and study aims: Wire-guided biliary cannulation (WGBC) is a standard technique during endoscopic retrograde cholangiopancreatography-related interventions. However, no dedicated guidewire is available. We investigated a novel “passive loop-forming WGBC” concept using a 0.035-inch ultra-deep angled tip guidewire. Patients and methods: This single-arm, single-center, retrospective study included consecutive 111 patients who underwent passive loop-forming WGBC as the first biliary intervention between October 2021 and December 2022. Results: WGBCs completed within 5 min and overall were performed at a median papillary negotiation time of 81 s (IQR, 39–170 s) and 114 s (IQR, 49–303 s) in 83 (74.8%) and 106 (95.5%) cases, respectively. Logistic regression analysis identified age ≥80 years (odds ratio [OR]: 3.56, 95% confidence interval [CI]: 1.12–11.31) and unintentional pancreatic guidewire insertion (OR: 17.67, 95% CI: 5.75–54.31) as significant risk factors for failed WGBC within 5 min. Among the 106 obtained cannulations, the guidewire leading part formed a small-looped tip and wide-looped body in 83 (78.3%) and 23 (21.7%) cases, respectively. Adverse events included post-procedure pancreatitis (2/111 [1.8%]) and guidewire penetration (3/111 [2.7%]). Conclusions: Passive loop-forming WGBC using an ultra-deep angled tip guidewire is a feasible procedure.

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“…As the lining of the mucosal duplications within the ampulla is highly vascular and filled with mucinous glands, factors that affect the thickness of this mucosa may explain the increased incidence of PEP with repeat cannulations or variations that contribute to difficult cannulations in certain patients. [19,20]…”

Section: Pathophysiologymentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

Patel,

Akshintala

2023

Journal of Pancreatology

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Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regards to both indications for its use and improvements in technique. The most common complication is post- endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multi-factorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female, sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal NSAIDs, aggressive IV fluid hydration and pancreatic duct stents. Appropriate patient selection and the use of non-invasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related and combination strategies for prevention and will be important as the use of ERCP continues to grow.

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Functional anatomy of the papilla Vateri

Cited by 14 publications

References 8 publications

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

A novel concept of passive loop-forming wire-guided biliary cannulation using an ultra-deep angled tip guidewire (with video)

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

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