Endoscopic assessment of minor papilla morphology: Predictors of successful cannulation and procedural pancreatitis risk in minor papilla endotherapy.

Autor: Kuraishi Y; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Nakamura A; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Kondo S; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Yanagisawa T; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Horiuchi I; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Minamisawa M; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Sasaki N; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Iwaya Y; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Nagaya T; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan., Umemura T; Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan.
Jazyk: angličtina
Zdroj: Journal of hepato-biliary-pancreatic sciences [J Hepatobiliary Pancreat Sci] 2024 Sep 09. Date of Electronic Publication: 2024 Sep 09.
DOI: 10.1002/jhbp.12068
Abstrakt: Background: We evaluated for predictors of successful cannulation and post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in minor papilla endotherapy (MPE), emphasizing endoscopic minor papilla morphology.
Methods: We retrospectively analyzed 232 MPEs in 65 patients, assessing minor papilla morphology based on three features: bulge as "prominent" or "subtle," mucosal appearance as "papilla-like" resembling the main papilla or "SMT-like" akin to a gastrointestinal submucosal tumor, and orifice visibility as "clear" or "unclear." Cannulation success was evaluated in 65 enrolled patients, with PEP risk assessed in all 232 MPEs.
Results: Minor papilla morphology was categorized as prominent/subtle bulge in 42/23 patients, papilla-like/SMT-like mucosal appearance in 42/23, and clear/unclear orifice visibility in 24/41. Cannulation succeeded in 54/65 patients (83%). A papilla-like appearance and clear orifice visibility was significantly associated with cannulation success. PEP incidence was 5.2% and predominantly mild. A papilla-like appearance significantly decreased PEP incidence, while precutting technique and orifice dilation significantly increased PEP risk.
Conclusion: Evaluating minor papilla morphology may help predict cannulation success and PEP risk in MPE. A papilla-like mucosal appearance prognosticates cannulation success and reduced PEP risk, with clear orifice visibility serving as a success predictor. These findings provide practical guidance for preprocedural planning by emphasizing the importance of minor papilla morphology evaluation.
(© 2024 The Author(s). Journal of Hepato‐Biliary‐Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)
Databáze: MEDLINE
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