{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:07:37Z","timestamp":1790636857169,"version":"4.1.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had na\u00efve major duodenal papilla. We used Haraldsson\u2019s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045) and Type 3 papilla (odd ratio 7.44,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014) and age (odd ratio\u2009=\u20091.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-020-01455-0","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T06:03:22Z","timestamp":1601273002000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study"],"prefix":"10.1186","volume":"20","author":[{"given":"Po-Han","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Fang","family":"Tung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Chung","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Zen","family":"Yeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Sen","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4407-2052","authenticated-orcid":false,"given":"Chia-Chang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,23]]},"reference":[{"key":"1455_CR1","doi-asserted-by":"publisher","first-page":"CD009662","DOI":"10.1002\/14651858.CD009662.pub2","volume":"12","author":"F Tse","year":"2012","unstructured":"Tse F, Yuan Y, Moayyedi P, Leontiadis GI. Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Cochrane Database Syst Rev. 2012;12:CD009662. https:\/\/doi.org\/10.1002\/14651858.CD009662.pub2.","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"1455_CR2","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1136\/gut.2006.097543","volume":"56","author":"EJ Williams","year":"2007","unstructured":"Williams EJ, Taylor S, Fairclough P, et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut. 2007;56(6):821\u20139 Published online 4 Dec 2006. https:\/\/doi.org\/10.1136\/gut.2006.097543.","journal-title":"Gut"},{"issue":"1","key":"1455_CR3","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/s0016-5107(04)02463-0","volume":"61","author":"ML Freeman","year":"2005","unstructured":"Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005 Jan;61(1):112\u201325. https:\/\/doi.org\/10.1016\/s0016-5107(04)02463-0.","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"1455_CR4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.4253\/wjge.v11.i1.5","volume":"11","author":"R Berry","year":"2019","unstructured":"Berry R, Han JY, Tabibian JH. Difficult biliary cannulation: historical perspective, practical updates, and guide for the endoscopist. World J Gastrointest Endosc. 2019 Jan 16;11(1):5\u201321. https:\/\/doi.org\/10.4253\/wjge.v11.i1.5.","journal-title":"World J Gastrointest Endosc"},{"issue":"6","key":"1455_CR5","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.gie.2019.07.030","volume":"90","author":"DG Adler","year":"2019","unstructured":"Adler DG. ERCP biliary cannulation difficulty as a function of papillary subtypes: a tale of shapes and Shar-Pei dogs. Gastrointest Endosc. 2019 Dec;90(6):964\u20135. https:\/\/doi.org\/10.1016\/j.gie.2019.07.030.","journal-title":"Gastrointest Endosc"},{"issue":"4","key":"1455_CR6","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1177\/2050640616674837","volume":"5","author":"E Haraldsson","year":"2017","unstructured":"Haraldsson E, Lundell L, Swahn F, et al. Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study. United European Gastroenterol J. 2017;5(4):504\u201310. Published online: 17 Oct 2016. https:\/\/doi.org\/10.1177\/2050640616674837.","journal-title":"United European Gastroenterol J"},{"issue":"3","key":"1455_CR7","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/s0016-5107(91)70740-2","volume":"37","author":"PB Cotton","year":"1991","unstructured":"Cotton PB, Lehman G, Vennes J. Endoscopic sphincterotomy complications and their management: an attempt at consensus. 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Our access to the data used in this study was approved by Ethical Review Board of Taichung Veterans General Hospital. The need for consent was waived by Ethical Review Board of Taichung Veterans General Hospital (Reference: CE19274B).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This research did not contain details, images, or videos relating to an individual person.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors state that they have no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"310"}}