IS THERE AN ASSOCIATION BETWEEN THE MAJOR PAPILLA MORPHOLOGY AND THE SIZE OF THE TERMINAL COMMON BILE DUCT? – A PROSPECTIVE COHORT STUDY

J Fernandes; M Moreira; T Araújo; I Costa; J Fonseca; H Ribeiro; S Giestas; F Lucas; D Libânio; D Martinez-Ares; G Alexandrino; D Horta; L Lourenço; J Reis; J Ramada; M Certo; J Canena; L Lopes

doi:10.1055/s-0039-1681717

Endoscopy, Table of Contents

Endoscopy 2019; 51(04): S185
DOI: 10.1055/s-0039-1681717

ESGE Days 2019 ePoster podium presentations

Saturday, April 6, 2019 13:30 – 14:00: ERCP cannulation 1 ePoster Podium 3

Georg Thieme Verlag KG Stuttgart · New York

IS THERE AN ASSOCIATION BETWEEN THE MAJOR PAPILLA MORPHOLOGY AND THE SIZE OF THE TERMINAL COMMON BILE DUCT? – A PROSPECTIVE COHORT STUDY

Authors

J Fernandes

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal

²Gastroenterology, Centro Hospitalar Cova da Beira, Covilhã, Portugal
M Moreira

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
T Araújo

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
I Costa

³Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
J Fonseca

⁴ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
H Ribeiro

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
S Giestas

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
F Lucas

⁵Serviço de Medicina do Hospital de Cascais, Cascais, Portugal
D Libânio

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal

⁶Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
D Martinez-Ares

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
G Alexandrino

⁷Gastroenterology, Hospital Amadora Sinta, Amadora, Portugal
D Horta

⁷Gastroenterology, Hospital Amadora Sinta, Amadora, Portugal
L Lourenço

⁷Gastroenterology, Hospital Amadora Sinta, Amadora, Portugal
J Reis

⁷Gastroenterology, Hospital Amadora Sinta, Amadora, Portugal
J Ramada

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
M Certo

⁸Hospital de Braga, Braga, Portugal
J Canena

⁷Gastroenterology, Hospital Amadora Sinta, Amadora, Portugal

⁹Gastroenterology, Nova Medical School/FCML da UNL, Lisbon, Portugal
L Lopes

¹Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal

³Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

⁴ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal

Abstract

Full Text

Aims:

In endoscopic retrograde cholangiopancreatography (ERCP), the risk of adverse events during precut is increased when the terminal bile duct (tBD) is not dilated. Some studies suggest that the major papilla morphology, particularly its width is determined by the prominence of the supra- and intra-duodenal portion of the tBD. The study aim was to assess if the terminal bile duct diameter can be determined by inspecting the major papilla morphology/width during duodenoscopy.

Methods:

Between July 2017 and January 2018, in 3 hospitals, all consecutive patients with naïve papilla referred for ERCP were eligible for enrollment. The transverse diameter (tD) of the papilla was measured using a comparative measurement technique (biopsy forceps) and a novel software (validity and reliability tested). The papilla morphology was classified into one of 4 groups: non-proeminent, proeminent, bulging, distorted. The tBD's diameter was measured in the distal 1 cm (cholangiogram acquired in supine/prone) in a workstation, by an independent researcher. Main outcome was evaluated using a Pearson correlation.

Results:

137 patients were included; 57 males (41.61%), median age of 78 years (26 – 99). The median tD of the papilla was 6 mm (IQR = 3 mm) and the median tBD's diameter was 8.07 mm (IQR = 4.87 mm). Half (50%) of the papillas were non-proeminent (tBD median = 7.66 mm; IQR = 4.473), 32.08% proeminent (tBD median = 8.05 mm; IQR = 4.869), 12.26% bulging (tBD median = 8.978 mm; IQR = 5.814) and 5.66% distorted (tBD median = 7.533 mm; IQR = 0.832); p-value [C2 = 2.237)] > 0.6923. The correlation between tD and tBD diameters was 0.0245.

Conclusions:

Despite what is suggested in the literature, the morphology and the width of the major papilla don't have any association with the diameter of the tBD, and consequently these two dimensions should not be taken into account when deciding for a cannulation technique.