Duodenal Papilla Morphology and ERCP Cannulation difficulties, failure and complications in Manila Doctors Hospital, a tertiary private hospital: A cross-sectional study

ABSTRACT

BACKGROUND/OBJECTIVE@#Different major duodenal papilla morphology pose various challenges of cannulation and development of ERCP complications. These morphologies may guide the endoscopist in his cannulation approach and complication prevention. The aim of this study is to determine the major duodenal papilla morphologies of ERCP patients in Manila Doctors Hospital and their associated cannulation difficulties, failure, and complications. @*METHODS@#This is a retrospective cross-sectional study of 246 ERCPs at the Manila Doctors Hospital from January 2017 to December 2018 with naive duodenal papillae classified according to Watanabe (2019) as follows oral protrusion (small, regular, large) and papilla pattern (annular, unstructured, longitudinal, isolated, gyrate). Association of papilla morphology with cannulation difficulties, failure, and complications were analyzed using logistic regression.@*RESULTS@#Among protrusions, small oral protrusions were more difficult to cannulate compared to regular (OR 0.493, p=0.017) and large protrusions (OR 0.702, p=0.426). Large protrusions had the highest risk for failed cannulation (OR 2.04, p=0.445). Among papilla patterns, unstructured papilla patterns had the highest risk for difficult (OR 3, p=0.008) and failed cannulation (OR 7.08, p=0.020). Complications developed in 7 in- patients with 3 (1.73%) post-ERCP pancreatitis, 1 (0.58%) post- sphincterotomy bleeding, and 1 (0.58%) cholangitis and 2 (1.16%) mortalities. One had myocardial infarction 2 days post-ERCP and another had septic shock after 2 days despite endoscopic biliary drainage and antibiotics.@*CONCLUSION@#Among protrusions, small oral protrusions had the highest risk for difficult cannulation while large protrusions had the highest risk for failed cannulation. Among papilla patterns, unstructured papilla patterns had the highest risk for difficult and failed cannulation.