Endoscopy 2025; 57(S 02): S236-S237
DOI: 10.1055/s-0045-1805577
Abstracts | ESGE Days 2025
Moderated poster
ERCP and EUS: moving forward together 04/04/2025, 11:30 – 12:30 Poster Dome 2 (P0)

The Impact of Papillary Morphology on Bile Duct Cannulation: Preliminary Insights from a Prospective Study

Authors

  • R el jim

    1   Faculty of Medicine and Pharmacy Fez, Fès, Morocco

  • L Maria

    2   CHU HASSAN II FES, Fes, Morocco

  • L Asmae

    3   CHU HASSAN II FES, Morocco, Fes, Morocco

  • H Abid

    2   CHU HASSAN II FES, Fes, Morocco

  • N Lahmidani

    2   CHU HASSAN II FES, Fes, Morocco

  • A Elmekkaoui

    2   CHU HASSAN II FES, Fes, Morocco

  • Y M El

    3   CHU HASSAN II FES, Morocco, Fes, Morocco

  • E A Mohammed

    4   Fes, Morocco

  • S A Ibrahimi

    3   CHU HASSAN II FES, Morocco, Fes, Morocco

  • D A Benajah

    5   CHU HASSAN II FES,MOROCCO, Fes, Morocco
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Aims The aim of our study was to evaluate whether the appearance of the papilla impacts the difficulty of cannulation.

Methods We conducted a prospective cross-sectional study over 13 months, including patients admitted for ERCP (excluding patients with difficult papilla access). The new papilla classification system was used as the basis for analysis.

Difficult cannulation was defined by the following criteria:

  • More than five attempts at papilla access,

  • A duration exceeding five minutes from the first attempt,

  • Inadvertent guidewire passage or contrast opacification of the Wirsung duct, Subjective difficulty assessed by the endoscopist using a scale of 1 to 5.

Results The study included 216 patients, with a female predominance (55.5%) and an average age of 61 years. The main indications for ERCP were bile duct stones (48%) and malignant strictures (30%). The papilla was located in the second portion of the duodenum (D2) in 81% of cases, at the superior genu in 16%, and in the third portion (D3) in the remaining cases.

The observed papilla types were distributed as follows:

  • Type I: 12.5% (n=27), Type IIa: 39.4% (n=85),

  • Type IIb: 15.7% (n=34), Type IIc: 11.1% (n=24),

  • Type IIIa: 4.2% (n=9), Type IIIb: 3.2% (n=7),

  • Type IV: 6.0% (n=13), Pre-sphincterotomized papilla: 7.4% (n=16).

  • Analysis revealed that type IIa and pre-sphincterotomized papillae were associated with a high success rate of standard cannulation techniques (p=0.04). However, the correlation between cannulation difficulty and other papilla types requires a larger sample size for more robust conclusions.

Conclusions The preliminary findings of this study partially confirm the correlation between the papilla's appearance and the difficulty of bile duct cannulation. Specifically, type IIa papillae were associated with a high success rate using standard cannulation techniques. However, further analysis involving larger sample sizes is needed to draw more reliable conclusions.



Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

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