Year 2026 / Volume 118 / Number 2
Original
Difficulty in cannulation and risk of complications after endoscopic retrograde cholangiopancreatography according to the type of papilla of Vater in a tertiary center

83-87

DOI: 10.17235/reed.2025.11475/2025

Renzo Pinto-Carta, Gustavo Adolfo Reyes Medina, Mariana Vásquez, Andrés Felipe Bejarano-Ramírez, María Alejandra Gómez-Gutiérrez, Fernando Sierra-Arango,

Abstract
Introduction: cannulation of the papilla of Vater is a critical step in endoscopic retrograde cholangiopancreatography (ERCP), with direct implications for procedural success and the risk of adverse events. Although endoscopist experience and anatomical variations are known contributors, the role of papillary morphology remains insufficiently explored in Latin America. This study aimed to assess the association between papilla type and cannulation difficulty or complications. Materials and methods: adults with a native major papilla undergoing ERCP at a tertiary center in Bogotá were prospectively enrolled. Papillary morphology was classified macroscopically, and difficult cannulation was defined according to the European Society of Gastrointestinal Endoscopy (ESGE) criteria. Associations were analyzed using Fisher’s exact test and odds ratios with 95 % confidence intervals. Fifty-eight patients (mean age 59.9 years, 63.8 % female) were included. Results: the most common papilla was type 1 (63.8 %), followed by type 3 (27.6 %). Difficult cannulation occurred in 13.8 % of procedures, mostly involving type 1, type 3, and the single type 4 case. Advanced cannulation techniques were required in 34.5 % of cases and were associated with longer procedural times. Prophylactic measures were used in 60.3 % of patients. Overall, 6.9 % developed post-ERCP pancreatitis and 3.4 % cholangitis. No significant association was found between papilla type and complication rate. Conclusion: our findings suggest that type 1 and type 3 papillae are more frequently associated with cannulation difficulty, although complication rates did not differ significantly by morphology. Recognizing papilla morphology may enhance preprocedural planning and training strategies in advanced endoscopy units.
Lay Summary
Endoscopic procedures are often used to examine and treat problems in the bile ducts and pancreas. One of these procedures, called ERCP, requires the doctor to insert a small tube through a natural opening in the small intestine called the papilla of Vater. However, this step, called “cannulation”, can sometimes be difficult, and when it is, the risk of complications increases. This study looked at what the papilla looks like in different people and whether its shape affects how hard it is to complete the procedure safely. We followed a group of adult patients who needed ERCP in a specialized hospital. The doctors performing the procedure carefully observed and recorded the shape of each patient’s papilla, how long it took to complete the procedure, and whether any complications occurred afterward. We found that two particular shapes of the papilla were more likely to make the procedure difficult, and that patients with these types sometimes needed more attempts or extra techniques. While most patients did well, some still experienced complications even when doctors used strategies to prevent them. Our findings suggest that the anatomy of the papilla plays an important role in how safe this common procedure is. Understanding these variations can help doctors plan better, reduce risks, and personalize care for each patient.
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Pinto-Carta R, Reyes Medina G, Vásquez M, Bejarano-Ramírez A, Gómez-Gutiérrez M, Sierra-Arango F, et all. Difficulty in cannulation and risk of complications after endoscopic retrograde cholangiopancreatography according to the type of papilla of Vater in a tertiary center. 11475/2025


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Publication history

Received: 07/07/2025

Accepted: 24/07/2025

Online First: 29/09/2025

Published: 09/02/2026

Article Online First time: 84 days

Article editing time: 217 days


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