Correlation of Major Duodenal Papilla Morphology with Difficult Bile Duct Cannulation

Aim: To study the effect of major duodenal papilla morphology on difficulty of bile duct cannulation in endoscopic retrograde cholangiopancreatography (ERCP) naïve patients.

Materials and Methods: This cross-sectional study included patients with naïve major duodenal papilla with desired duct of cannulation being bile duct and ERCP to be performed by an expert endoscopist. The papilla was classified as per Haraldsson’s classification in to type 1–4. The time taken to successfully cannulate bile duct, number of attempts, and pancreatic duct passages were recorded. Difficult cannulation was defined as per ESGE expand definition of more than 5 minutes, more than 5 attempts or 2 or more guidewire passages in pancreatic duct.

Results: A total of 176 patients were included in the study. We found type 1 papilla was most frequent (n = 76, 40%), followed by type 2 (n = 57, 32%), type 3 (n = 24, 14%), and type 4 (n = 25, 14%). Difficult cannulation was present in 57 (32%) of patients. Proportion of difficult cannulation was highest in type 3 (n = 13, 54%) followed by type 2 (n = 19, 33%), type 1 (n = 20, 27%), and type 4 (n = 5, 20%). On application of regression analysis, it was found that papilla type 3 was significantly associated with difficult cannulation (p = 0.026). We also found significant association of difficult cannulation with increased age (p = 0.007), and post-ERCP adverse events (p = 0.008).

Conclusion: Papilla morphology was found to have a significant bearing on the difficulty of biliary cannulation. Papilla type 3 was found to have a significant association with difficult cannulation in our study. We also found that increasing age also significantly increases difficult cannulation.

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Artikel online veröffentlicht:
22. April 2024