A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä

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




TekijätHaraldsson Erik, Kylänpää Leena, Grönroos Juha, Saarela Arto, Toth Ervin, Qvigstad Gunnar, Hult Mari, Lindström Outi, Laine Simo, Karjula Heikki, Hauge Truls, Sadik Riadh, Arnelo Urban

Julkaisuvuosi2019

JournalGastrointestinal Endoscopy

Vuosikerta90

Numero6

Aloitussivu957

Lopetussivu963

Sivujen määrä7

ISSN0016-5107

eISSN1097-6779

DOIhttps://doi.org/10.1016/j.gie.2019.07.014

Verkko-osoitehttps://doi.org/10.1016/j.gie.2019.07.014

Rinnakkaistallenteen osoitehttps://research.utu.fi/converis/portal/detail/Publication/42757361


Tiivistelmä
Background and Aims

Certain appearances of the major duodenal papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the major duodenal papilla to determine if certain types of papilla predispose to difficult cannulation.

Methods

Patients with a naïve papilla scheduled for ERCP were included. The papilla was classified into 1 of 4 papilla types before cannulation started. Time to successful bile duct cannulation, attempts, and number of pancreatic duct passages were recorded. Difficult cannulation was defined as after 5 minutes, 5 attempts, or 2 pancreatic guidewire passages.

Results

A total of 1401 patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% confidence interval [CI], 39%-44%). Type 2 small papilla (52%; 95% CI, 45%-59%) and type 3 protruding or pendulous papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with type 1 regular papilla (36%; 95% CI, 33%-40%; both P < .001). If an inexperienced endoscopist started cannulation, the frequency of failed cannulation increased from 1.9% to 6.3% (P < .0001), even though they were replaced by a senior endoscopist after 5 minutes.

Conclusions

The endoscopic appearance of the major duodenal papilla influences bile duct cannulation. Small type 2 and protruding or pendulous type 3 papillae are more frequently difficult to cannulate. In addition, cannulation might even fail more frequently if a beginner starts cannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists.


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