Does papilla morphology affect biliary cannulation during endoscopic retrograde cholangiopancreatography?

Aims Biliary cannulation failure is a major problem during endoscopic retrogradecholangiopancreatography. The influence of morphology of the major duodenal papilla on theoutcome of standard biliary cannulation remains unclear.We aimed to study the impact of papilla morphological charecteristics on the outcome ofbiliary cannulation.

Methods We conducted a single-center retrospective study including all patients with naïve papilla who had an ERCP procedure for CBD stones in Gastroenterology department of Mohamed Taher Maamouri Hospital from June 2017 to December 2022.

Results We included 489 patients. The morphology of the papilla was predominantly normal(93%). A small or protruding papilla was noted in 5% and 2% of patients, respectively. Thepapilla was hidden by a fold in 1,2% of cases and had a difficult orientation in 2,2% ofcases. The standard catheterization techniques were successful in 429 patients (86.14%).Advanced techniques were utilized 60 patients (13,8%) with success in 38 patients (32 fistulotomies, 7 transpancreatic sphincterotomies, 6 catheterizations through choledochoduodenal fistula and 3 papillotomies). In univariate analysis, we found that: small papilla, protruding papilla, hidden papilla and difficult orientation of the papilla were significantly associated with failed biliary cannulation (p<0,001). Multivariate analysis evidenced a direct and independent association between bile duct cannulation and small papilla (p=0,032; OR=6,06), papilla hidden by a fold (p=0,005; OR=13,12), and difficultorientation of the papilla (p=0.01; OR=13,31).

Conclusions The endoscopic charecteristics of the major duodenal papilla influences bile ductcannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists.

Publication History

Article published online:
27 March 2025