Duodenal major papilla morphology can predict ERCP procedural outcomes and adverse events, a prospective study

Aims We aimed to assess whether papillary morphology predicts ERCP procedural outcomes and adverse events.

Methods A prospective analysis was performed of patients undergoing ERCP for biliary indications. 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). The primary outcome was failing SBC and post-ERCP pancreatitis (PEP), with secondary outcomes including other adverse events and procedural outcomes such as inadvertent pancreatic duct cannulation, cannulation time, and attempts.

Results A total of 246 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 9.61% and 5.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 6.78, p=0.031) and Type 3 papilla (odd ratio 6.84, p=0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 6.35, p=0.011) and age (odd ratio=2.11, p=0.021) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.012) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. [1] [2]

Conclusions 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. Understanding this is key for managing intraprocedural approaches and minimizing adverse events.

Publication History

Article published online:
15 April 2024

• References

• 1 Chen PH, Tung CF, Peng YC, Yeh HZ, Chang CS. Chen CC Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study. BMC Gastroenterology 2020; 20: 310
• 2 Haraldsson E, Kylänpää L, Grönroos J.. Macroscopic appearance of the major duodenal papilla influences bile duct cannulation: a prospective multicenter study by the Scandinavian Association for Digestive Endoscopy Study Group for ERCP GASTROINTESTINAL ENDOSCOPY. Volume -, No. – 2019.