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  • Haraldsson, Erik,1972Karolinska Institutet,Karolinska Institute,Skaraborg Hospital (author)

Macroscopic appearance of the major duodenal papilla influences bile duct cannulation: a prospective multicenter study by the Scandinavian Association for Digestive Endoscopy Study Group for ERCP

  • Article/chapterEnglish2019

Publisher, publication year, extent ...

  • Elsevier BV,2019

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  • LIBRIS-ID:oai:gup.ub.gu.se/286778
  • https://gup.ub.gu.se/publication/286778URI
  • https://doi.org/10.1016/j.gie.2019.07.014DOI
  • https://lup.lub.lu.se/record/9d3f02b7-a082-43be-842c-815c57eb5ae3URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:142328194URI

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  • Language:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Background and Aims: Certain appearances of the major duodenal papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the major duodenal papilla to determine if certain types of papilla predispose to difficult cannulation. Methods: Patients with a naïve papilla scheduled for ERCP were included. The papilla was classified into 1 of 4 papilla types before cannulation started. Time to successful bile duct cannulation, attempts, and number of pancreatic duct passages were recorded. Difficult cannulation was defined as after 5 minutes, 5 attempts, or 2 pancreatic guidewire passages. Results: A total of 1401 patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% confidence interval [CI], 39%-44%). Type 2 small papilla (52%; 95% CI, 45%-59%) and type 3 protruding or pendulous papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with type 1 regular papilla (36%; 95% CI, 33%-40%; both P <.001). If an inexperienced endoscopist started cannulation, the frequency of failed cannulation increased from 1.9% to 6.3% (P <.0001), even though they were replaced by a senior endoscopist after 5 minutes. Conclusions: The endoscopic appearance of the major duodenal papilla influences bile duct cannulation. Small type 2 and protruding or pendulous type 3 papillae are more frequently difficult to cannulate. In addition, cannulation might even fail more frequently if a beginner starts cannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists. © 2019 American Society for Gastrointestinal Endoscopy

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  • Kylänpää, L.Helsinki University Central Hospital (author)
  • Grönroos, J.Turku University Hospital (author)
  • Saarela, A.Oulu University Hospital (author)
  • Toth, ErvinLund University,Lunds universitet,Gastroenterologi,Forskargrupper vid Lunds universitet,Gastroenterology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)ront-eto (author)
  • Qvigstad, G.St. Olav’s University Hospital (author)
  • Hult, M.Karolinska Institutet,Karolinska Institute,Karolinska University Hospital (author)
  • Lindström, O.Helsinki University Central Hospital (author)
  • Laine, S.Turku University Hospital (author)
  • Karjula, H.Oulu University Hospital (author)
  • Hauge, T.Oslo university hospital (author)
  • Sadik, Riadh,1963Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Sahlgrenska Academy(Swepub:gu)xsadri (author)
  • Arnelo, U.Karolinska Institutet,Karolinska Institute,Karolinska University Hospital (author)
  • Karolinska InstituteSkaraborg Hospital (creator_code:org_t)

Related titles

  • In:Gastrointestinal Endoscopy: Elsevier BV90:6, s. 957-9630016-51071097-6779

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