Diagnostic significance of a dilated orifice of the duodenal papilla in intraductal papillary mucinous neoplasm of the pancreas.

BACKGROUND

A dilated orifice of the duodenal papilla found during screening endoscopy or ERCP is well-known as one of the specific findings of intraductal papillary mucinous neoplasm (IPMN). However, its clinical significance is still unclear.

OBJECTIVE

To assess the diagnostic significance of a dilated orifice of the duodenal papilla and evaluate whether this could be a factor predictive of malignancy or a subtype of IPMN.

DESIGN

Retrospective study.

SETTING

University hospital.

PATIENTS

This study involved 149 patients who underwent pancreatectomy for IPMN between January 1987 and June 2011.

INTERVENTION

ERCP.

MAIN OUTCOME MEASUREMENTS

The rate of malignant and intestinal type IPMNs in patients with and without papillary dilation.

RESULTS

A dilated orifice of the duodenal papilla was significantly associated with intestinal type IPMN (P < .001), but this finding could not predict the malignant grade of IPMN (P = .13). Multivariate analysis revealed that a dilated orifice was a significant factor for predicting intestinal type in both main duct (P = .01) and branch duct IPMNs (P < .001).

LIMITATIONS

The validity of the definition of papillary dilation, selection bias, and a retrospective study.

CONCLUSION

A dilated orifice of the duodenal papilla could be a significant factor for predicting intestinal type IPMN. This may lead to better clinical management of patients with IPMN.