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

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yasuhiro Kuraishi, Akira Nakamura, Shohei Kondo, Takumi Yanagisawa, Ichitaro Horiuchi, Masafumi Minamisawa, Nobukazu Sasaki, Yugo Iwaya, Tadanobu Nagaya, Takeji Umemura
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Abstract

BackgroundWe evaluated for predictors of successful cannulation and post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in minor papilla endotherapy (MPE), emphasizing endoscopic minor papilla morphology.MethodsWe 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.ResultsMinor 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.ConclusionEvaluating 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.
小乳头形态的内窥镜评估:小乳头内窥镜疗法中成功插管和手术性胰腺炎风险的预测因素
背景我们评估了小乳头内切术(MPE)中成功插管和内镜逆行胰胆管造影术(ERCP)后胰腺炎(PEP)的预测因素,强调了内镜小乳头形态。方法我们回顾性分析了 65 位患者的 232 例 MPE,根据以下三个特征评估小乳头形态:隆起为 "突出 "或 "微小",粘膜外观为类似主乳头的 "乳头样 "或类似胃肠粘膜下肿瘤的 "SMT 样",孔口可见度为 "清晰 "或 "不清晰"。结果42/23 例患者的轻度乳头形态分为突出/微小隆起,42/23 例患者的乳头样/SMT 样粘膜外观,24/41 例患者的孔口可见度为清晰/不清晰。54/65 例患者(83%)成功进行了插管。乳头样外观和管口清晰可见与插管成功率明显相关。PEP 发生率为 5.2%,主要为轻度。乳头样外观可明显降低 PEP 发生率,而预切割技术和管口扩张则会明显增加 PEP 风险。乳头状粘膜外观预示着插管的成功率和 PEP 风险的降低,清晰的管口可见度也是预测成功率的一个指标。这些发现强调了小乳头形态评估的重要性,为术前规划提供了实用指导。
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来源期刊
Journal of Hepato‐Biliary‐Pancreatic Sciences
Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY
自引率
10.00%
发文量
178
审稿时长
6-12 weeks
期刊介绍: The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.
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