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

Air Force Military Medical University, China658 enrolled

Overview

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.

Study Type

OBSERVATIONAL

Enrollment

658

Conditions

Pancreaticobiilary Diseases Endoscopic Retrograde Cholangiopancreatography

Interventions

MDP

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

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

Locations (4)

Department of gastroenterology, Successful Hospital of Xiamen university

Xiamen, Fujian, China

Huaihe Hospital of Henan University

Kaifeng, Henan, China

Endoscopic center, Xijing Hospital of Digestive Diseases

Xi'an, Shaanxi, China

Department of gastroenterology, Second Affiliated Hospital of Chongqing Medical University

Chongqing, China

Outcomes

Primary Outcomes

post-ERCP pancreatitis incidence

frequency of post-ERCP pancreatitis

Time frame: 48 hours

Secondary Outcomes

Rate of difficult cannulation

difficult cannulation was defined as when total cannulation time was more than 5minutes, total cannulation attempts more than 5 times or inadvertent pancreatic duct cannulation more than 1 time.

Time frame: 3 hours

Cannulation attempts

the sphincterotome touching the papilla for at least 5 seconds will be considered as one attempt.

Time frame: 3 hours

Total cannulation time

the time from the moment the sphincterotome touch the papilla to the guide wire advance into the target duct.

Time frame: 3 hours

Unintended pancreatic duct cannulation

the guide wire unintentionally entered into the undesired pancreatic duct

Time frame: 3 hours

Complication rate

frequency of any adverse outcome that required hospital admission or prolonged hospital stay necessary for management of the complication, including pancreatitis, bleeding, biliary infection or perforation.

Time frame: 48 hours