Impact of Duodenal Papilla Morphology on the Success of Transpancreatic Precut Sphincterotomy.

Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE

Original Publication: Basel, Switzerland : MDPI AG, [2012]-

Background : This study aimed to evaluate whether the morphology of the duodenal major papilla is linked to transpancreatic precut sphincterotomy (TPS) failure. Methods : We conducted a retrospective review of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at our institution. The inclusion criteria involved patients with a naïve major duodenal papilla who required TPS due to difficult biliary cannulation. Papilla morphology was classified using Haraldsson's system, as follows: regular (Type 1), small (Type 2), protruding or pendulous (Type 3), and creased or ridged (Type 4). The analysis focused on identifying risk factors for TPS failure and related complications. Results : A total of 103 cases were analyzed, with an overall TPS success rate of 85.44%. There were no significant differences in age, gender, ERCP indications, or the prevalence of juxtapupillary diverticula across the four papilla types. The TPS failure rates by papilla type were Type 1 (10.53%), Type 2 (0%), Type 3 (16.67%), and Type 4 (28%). Type 4 papilla had a significantly higher failure rate compared to Type 1 and Type 2 in the univariate analysis ( p = 0.028), but this was not statistically significant in the multivariate analysis ( p = 0.052). Age emerged as an independent risk factor for TPS failure. Conclusions : Duodenal papilla morphology may influence the success rate of TPS, with advanced age being a key risk factor for failure. Identifying high-risk factors such as Type 4 papilla and older age can help endoscopists adjust their techniques early, potentially improving outcomes and minimizing complications.

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TCVGH-1113001A, TCVGH-1123303B, TCVGH-1138902E. Taichung Veterans General Hospital

Keywords: duodenal papillary morphology; endoscopic retrograde cholangiopancreatography; papillary cannulation; transpancreatic precut sphincterotomy

Date Created: 20241127 Latest Revision: 20241130

20241202

PMC11594982

10.3390/jcm13226940

39598086