Effect of Anatomy of Major Duodenal Papilla on the Difficulty of Cannulation During Endoscopic Retrograde Cholangiopancreatography

Effect of Anatomy of Major Duodenal Papilla on the Difficulty of Cannulation During Endoscopic Retrograde Cholangiopancreatography (ERCP)

Selective cannulation is an essential step for the success of ERCP. The successful cannulation is influenced by types of disease (such as Sphincter of Oddi Dysfunction and duodenal stricture), the experience of endoscopists and the anatomy of papilla. It is suggested that the size, morphology, orientation and location of major duodenal papilla (MDP), could cause a difficult cannulation (Endoscopy 2016; 48: 657-683). However, the related evidences are limited. The investigators hypothesized that special anatomy of papilla, such as a lanky shape (defined by the higher ratio of length to width) and a deeper location, could increase the difficulty of cannulation. Here the investigators investigated the effects of the anatomy of major duodenal papilla on post-ERCP pancreatitis and the procedure of cannulation in patients undergoing ERCP.

Inclusion Criteria:

• age 18-80
• Patients with native papilla who underwent ERCP

Exclusion Criteria:

• Prior endoscopic sphincterotomy
• Minor pancreatic duct as the targeted duct
• History of prior upper gastrointestinal surgery, such as Billroth I, II and Roux-en-Y
• Fistula of MDP
• Papillary carcinoma or adenoma
• Duodenal obstruction, type II
• Prior stent placement in common bile duct or pancreatic duct
• Pregnant or breastfeeding women
• Unwilling or inability to provide consent