Correlation Between Different Shapes of Major Papilla With Outcomes of Endoscopic Retrograde Cholangiopancreatography in a Prospective Study

Introduction: Several factors affect the difficulty, clinical success, and side effects related to endoscopic retrograde cholangiopancreatography (ERCP), of which the endoscopic appearance of the major papilla is one of the most important. This study aimed to investigate the outcomes related to ERCP in relation to major papilla morphology. Methods: This study was performed prospectively on 581 patients undergoing ERCP. During ERCP, the endoscopist determined the morphology of the major papilla before the cannulation. Primary outcomes included overall operative success rate and post-ERCP pancreatitis (PEP) at 30 days. Secondary outcomes included clinically significant bleeding, perforation, cholangitis or sepsis, difficult cannulation, number of cannulation attempts, and duration of cannulation. Results: Papilla type 2 (OR=2.36, 95% CI: 1.07-5.20) and type 3b (OR=3.19, 95% CI: 1.16-8.73) were associated with decreased odds of procedure success. PEP was directly associated with type 4 papilla (OR=3.30, 95% CI: 1.21-8.98). There were direct correlation between difficult cannulation and types 3a (OR=1.89, 95% CI: 1.20-2.98) and 3b (OR=5.05, 95% CI: 1.98-12.86), cannulation duration more than 10 minutes and types 2 (OR=2.66, 95% CI: 1.31-5.39), 3a (OR=2.18, 95% CI:1.30-3.64), and 3b (OR=4.97, 95% CI: 1.94-12.71), and attempted cannulation more than 5 times and types 3a (OR=1.64, 95% CI: 1.01-2.69), and 3b (OR=4.40, 95% CI: 1.75-11.09). Conclusion: The findings of this study showed that ERCP failure is associated with types 2 and 3b papilla, and papilla type 4 is an independent risk factor for PEP.