Papilla of Vater morphology as an influencing factor in successful cannulation during resident training in advanced endoscopy. A prospective clinical study

• Published in: Revista de Gastroenterología de México (English Edition) 2024-04, Vol.89 (2), p.237-242
• Main Authors: Benavides-Salgado, D.E., Jiménez-Castillo, R.A., Cuéllar-Monterrubio, J.E., Jáquez-Quintana, J.O., Garza-Galindo, A., Cortes-Hernández, C., Maldonado-Garza, H.J., García-Compeán, D., González-González, J.A.
• Format: Article
• Language: English
• Subjects: Adult; Advanced training in ERCP; Aged; Aged, 80 and over; Ampulla of Vater - anatomy & histology; Ampulla of Vater - diagnostic imaging; Catheterization - methods; Cholangiopancreatography, Endoscopic Retrograde - methods; Clinical Competence; Complicaciones; Complications; Entrenamiento avanzado en CPRE endoscopia; Female; Humans; Internship and Residency; Male; Middle Aged; Papila de Vater; Papilla of Vater; Prospective Studies; Sphincterotomy, Endoscopic - education
• ISSN: 2255-534X; 2255-534X
• DOI: 10.1016/j.rgmxen.2023.08.001

Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started. La colangiografía retrograda endoscópica (CPRE) es un procedimiento complejo. Las guías clínicas evalúan la competencia en CPRE mediante un número definido de procedimientos, sin embargo, existen múltiples factores que influyen en ello. El objetivo fue analizar la morfología de la papila de Vater como factor independiente en la canulación selectiva del colédoco durante el entrenamiento del residente. Se estudiaron pacientes sometidos a CPRE de manera consecutiva. Todas las CPRE fueron iniciadas por el residente. Se clasificó el tipo de papila según Haraldsson, incluyendo a las papilas con esfinterotomía previa. La dificultad, el éxito en la canulación y su relación con el tipo de papila fueron documentados. El análisis se dividió en tres períodos de cuatro meses. De los 429 pacientes se determinó canulación difícil en 101 (23.5%). Los residentes lograron una canulación selectiva del colédoco en 276 (64.3%) y su éxito de canulación al final de su entrenamiento fue del 81.7%. La papila con esfinterotomía previa representó la menor dificultad en la canulación (2.8%), a diferencia de la papila tipo 4 qu