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Abstract
: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding endoscopic procedure. ERCP outcome is affected by many factors like operator experience and disease state. The effect of morphological variations of the duodenum and major papilla on ERCP outcome was not well known. Methods: 68 patients have undergone ERCP with therapeutic intention, from June 2005 to March 2007. We have classified patients according to morphology of the duodenum and major papilla into 4 groups. Rates of cannulation success, post-ERCP complications and mortality have been noted. Results: Overall cannulation success rate, post-ERCP complications’ rate and mortality rate have been 92.65%, 10.29% and 1.47% respectively.
Patients with morphological duodenal variation and those with ectopic papilIa have had significantly difficult cannulation and low cannulation success rates. We have found a significant impact of morphological variations of both the duodenum and papilla on post-ERCP cholangitis and mortality, but, no
significant impact of morphological variations on post-ERCP pancreatitis or hemorrhage. Conclusion: Morphological variations of the duodenum and/or the major papilla are found in more than 2/3 of patients subjected to ERCP. Morphological variations of the duodenum and papilla are associated with poor ERCP outcome;
difficult cannulation, low cannulation success rate, high post- ERCP complications’ rate and mortality rate. The aim of this work has been studying the morphological variation of the duodenum and the major papilla and their impact on ERCP outcome.