DOES THE MORPHOLOGY OF THE MAJOR PAPILLA INFLUENCE BILIARY CANNULATION? – A MULTICENTER PROSPECTIVE STUDY

Aims:

Selective biliary duct cannulation is an essential prerequisite for biliary ERCP. Some authors suggest that the difficulty of biliary cannulation and the use of rescue techniques (rT) can be conditioned, among other factors, by the papillary morphology. We intend to evaluate if the duration of biliary cannulation, the existence of a difficult cannulation and the use of rT are influenced by the papillary morphology.

Methods:

This was a multicenter (3) prospective cohort study, including consecutive patients referred for ERCP with naïve papilla between August 2017 and January 2018, performed by experienced endoscopists. The papillae were classified into 4 types: non-prominent/prominent/bulging/distorted (Lee's classification). The transverse, longitudinal papilla diameters and the diameter of the distal bile duct were measured. Primary outcomes: duration of biliary cannulation (tbc), difficult cannulation and rT. The influence of papilla type/dimensions on outcomes was assessed by multiple linear and logistic regressions.

Results:

We included 106 patients, 43 men (40.57%), median age = 79 years (26 – 96). The main indication: suspected obstruction of the biliary tract in 83.02%. The success rate of biliary cannulation was 100%; 29.24% of the cannulations were considered difficult. Rescue access techniques were used in 28.3% of the non-prominent papillae, 41.18% of the prominent ones, 30.77% of the bulging and 16.67% of the distorted ones. In patients with non-prominent papillae (50%), tbc = 3.35 mins (iqr = 6.84); in the prominent papillae (32%), tbc = 5.08 mins (iqr = 8.53); in the bulging papillae (12.26%), the tbc = 2.25 mins (iqr = 5.66); in the distorted (5.66%), tbc = 2,025 mins (iqr = 7.51). In the multivariate analyzes the papilla type/dimensions did not show to be a predictor of the 3 outcomes evaluated.

Conclusions:

Contrary to what is stated in the literature, the type and dimensions of the papilla do not correlate with the difficulty of cannulation nor condition the techniques used.