Chen Yi-Peng, Liao Yi-Jun, Peng Yen-Chun, Tung Chun-Fang, Tsai Hsin-Ju, Yang Sheng-Shun, Chen Chia-Chang
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan.
J Clin Med. 2024 Nov 18;13(22):6940. doi: 10.3390/jcm13226940.
: This study aimed to evaluate whether the morphology of the duodenal major papilla is linked to transpancreatic precut sphincterotomy (TPS) failure. : We conducted a retrospective review of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at our institution. The inclusion criteria involved patients with a naïve major duodenal papilla who required TPS due to difficult biliary cannulation. Papilla morphology was classified using Haraldsson's system, as follows: regular (Type 1), small (Type 2), protruding or pendulous (Type 3), and creased or ridged (Type 4). The analysis focused on identifying risk factors for TPS failure and related complications. : A total of 103 cases were analyzed, with an overall TPS success rate of 85.44%. There were no significant differences in age, gender, ERCP indications, or the prevalence of juxtapupillary diverticula across the four papilla types. The TPS failure rates by papilla type were Type 1 (10.53%), Type 2 (0%), Type 3 (16.67%), and Type 4 (28%). Type 4 papilla had a significantly higher failure rate compared to Type 1 and Type 2 in the univariate analysis ( = 0.028), but this was not statistically significant in the multivariate analysis ( = 0.052). Age emerged as an independent risk factor for TPS failure. : Duodenal papilla morphology may influence the success rate of TPS, with advanced age being a key risk factor for failure. Identifying high-risk factors such as Type 4 papilla and older age can help endoscopists adjust their techniques early, potentially improving outcomes and minimizing complications.
本研究旨在评估十二指肠主乳头的形态是否与经胰管预切开括约肌切开术（TPS）失败相关。我们对在本机构接受内镜逆行胰胆管造影（ERCP）的患者进行了回顾性研究。纳入标准包括因胆管插管困难而需要进行TPS的初发十二指肠主乳头患者。乳头形态采用哈拉尔德松系统分类如下：规则型（1型）、小型（2型）、突出或下垂型（3型）和皱折或嵴状型（4型）。分析重点在于确定TPS失败及相关并发症的危险因素。共分析了103例病例，TPS总体成功率为85.44%。四种乳头类型在年龄、性别、ERCP适应证或壶腹旁憩室患病率方面无显著差异。按乳头类型划分的TPS失败率分别为：1型（10.53%）、2型（0%）、3型（16.67%）和4型（28%）。在单因素分析中，4型乳头的失败率显著高于1型和2型（P = 0.028），但在多因素分析中无统计学意义（P = 0.052）。年龄是TPS失败的独立危险因素。十二指肠乳头形态可能影响TPS的成功率，高龄是失败的关键危险因素。识别4型乳头和高龄等高危因素有助于内镜医师尽早调整技术，可能改善预后并减少并发症。
