Summary
Through the experience of fiberduodenoscopy, the endoscopic aspects on the dynamics
of the duodenal papilla is reported here. Characteristic appearance of the duodenal
papilla is hemispherical protrusion on the longitudinal fold associated with proximal
preputium-like circular folds and distal frenulum-like longitudinal folds. Color of
the papilla varies case by case from reddish to pale, pearly white. The arrangement
of the villi on the surface of the papilla seems to be different from surrounding
mucosa. The appearance of the papilla is classified into three types; papillar type,
hemispherical type and flat type. There may be transition from one type to another
in the same case during observation. The accessory papilla can also be detected endoscopically
if any. After stimulation with pancreozymin, thick bile flows out of the orifice.
The dynamics of bile excretion are reported. During the phase of excretion, a valvular
protrusion from inside of the orifice is sometimes observed, which is supposed to
be the septum in the ampulla.
Key-Words
Fiberduodenoscopy - main and accessory duodenal papilla - valvular protrusion - dynamics
of bile excretion
