Difficulty in Cannulation and Risk of Complications After ERCP According to the Type of Papilla of Vater in a Tertiary Center.

Abstract

Cannulation of the papilla of Vater is a critical step in endoscopic retrograde cholangiopancreatography (ERCP), with direct implications for procedural success and the risk of adverse events. Although endoscopist experience and anatomical variations are known contributors, the role of papillary morphology remains insufficiently explored in Latin America. This study aimed to assess the association between papilla type and cannulation difficulty or complications. Adults with a native major papilla undergoing ERCP at a tertiary center in Bogotá were prospectively enrolled. Papillary morphology was classified macroscopically, and difficult cannulation was defined according to ESGE criteria. Associations were analyzed using Fisher's exact test and odds ratios with 95% confidence intervals. Fifty-eight patients (mean age 59.9 years, 63.8% female) were included. The most common papilla was type 1 (63.8%), followed by type 3 (27.6%). Difficult cannulation occurred in 13.8% of procedures, mostly involving type 1, type 3, and the single type 4 case. Advanced cannulation techniques were required in 34.5% of cases and were associated with longer procedural times. Prophylactic measures were used in 60.3% of patients. Overall, 6.9% developed post-ERCP pancreatitis and 3.4% cholangitis. No significant association was found between papilla type and complication rate. Our findings suggest that type 1 and type 3 papillae are more frequently associated with cannulation difficulty, although complication rates did not differ significantly by morphology. Recognizing papilla morphology may enhance preprocedural planning and training strategies in advanced endoscopy units.