Department of Internal Medicine, Kyung Hee University School of Medicine, East-West Neo Medical Center, Sangil-dong Gangdong-gu, Seoul, 134-090, Korea.
Dig Dis Sci. 2011 Oct;56(10):2895-9. doi: 10.1007/s10620-011-1668-0. Epub 2011 Mar 30.
The purpose of this study was to assess the feasibility of forward-viewing upper endoscopy for detection of the major duodenal papilla (MDP) as an indicator of the descending duodenum.
A total of 338 patients were prospectively enrolled. Upper endoscopy was first performed by a routine method for all patients, and a subsequent straightening endoscopic technique, straightening the loop by withdrawal of the scope, was performed if the MDP was not identified during the routine method.
Findings of MDP observation using the upper endoscope could be categorized into five types: Type I, whole area of the papilla; Type II, upper part of the papilla, including the orifice; Type III, upper part of the papilla without the orifice; Type IV, lower part of the papilla, including the orifice; Type V, no part of the papilla was found. Upper endoscopy by a routine method detected the MDP in whole or in part in 194 patients (57.4%). Among 144 patients whose MDP could not be detected by use of a routine method, the MDP was identified by a subsequent straightening endoscopic technique in 108 patients (75.0%). Overall rate of observation of the MDP during full upper endoscopy was 89.3% (302/338). Type I is the most frequent (n = 185, 54.7%), followed by Type IV (n = 73, 21.6%), Type II (n = 23, 6.8%), and Type III (n = 21, 6.2%), in that order.
Our results support the value of forward-viewing endoscopy in observation of the MDP. Use of a straightening endoscopic technique, in particular, increases in the rate of detection of the MDP.
本研究旨在评估正向观察式上消化道内镜检查作为降段十二指肠的标志来检测主要十二指肠乳头（MDP）的可行性。
共前瞻性纳入 338 例患者。所有患者首先采用常规方法行上消化道内镜检查，如果常规方法未发现 MDP，则采用拉直内镜技术（通过退出内镜拉直肠袢）进行后续检查。
采用上消化道内镜观察 MDP 的结果可分为以下 5 种类型：Ⅰ型，整个乳头区域；Ⅱ型，乳头上部，包括开口；Ⅲ型，乳头上部无开口；Ⅳ型，乳头下部，包括开口；Ⅴ型，未发现乳头任何部位。194 例患者（57.4%）的常规方法可观察到全或部分 MDP。144 例常规方法无法检测到 MDP 的患者中，108 例（75.0%）患者采用后续拉直内镜技术可识别 MDP。整个上消化道内镜检查中 MDP 的总观察率为 89.3%（302/338）。Ⅰ型最常见（n=185，54.7%），其次是Ⅳ型（n=73，21.6%）、Ⅱ型（n=23，6.8%）和Ⅲ型（n=21，6.2%）。
我们的研究结果支持正向内镜检查在观察 MDP 中的价值。特别是使用拉直内镜技术可提高 MDP 的检出率。
