PhD Scientific Days 2025

Poster Session III. - P: Health Sciences

The impact of papilla morphology on the choice of advanced cannulation techniques in ERCP - insights from an international survey

Name of the presenter

Tari Edina

Institute/workplace of the presenter

Institute of Pancreatic Diseases, Semmelweis University

Authors

Edina Tari¹, Bálint Erőss¹

1: Institute of Pancreatic Diseases, Semmelweis University

Text of the abstract

Aims
Endoscopic retrograde cholangiopancreatography (ERCP) is the main therapeutic method for pancreaticobiliary disorders, yet cannulation fails in 5–20% of cases even among experts. The Haraldsson classification (2017) identifies four papilla types, some linked to higher failure and complication rates. Limited data exist on the role of papilla morphology in rescue techniques. We hypothesize that tailoring these to papilla type may reduce failure. This study surveys ERCP practitioners to explore this influence.
Method
An international survey was distributed via professional networks to ERCP-performing physicians, focusing on how papilla morphology affects cannulation. Designed in REDCap, it includes questions on demographics, experience, papilla classification, and preferred techniques. Responses are anonymous. Descriptive statistics are applied, and further analysis is planned. The survey remains open to ensure wide participation.
Results
Among 141 respondents, 27% reported using a classification system for papilla morphology. Of these, 57.9% were affiliated with certified training centers and 60.5% with university hospitals. More than five years of ERCP experience was reported by 55.3% of classification users and 67% of non-users.
Cannulation strategies varied based on papilla type and guidewire placement.
For type I papilla, without pancreatic duct access, NKP was most common (35.5%), followed by NKF (30.5%) and standard technique (28.4%). If the guidewire entered the pancreatic duct, DGT was preferred (54.6%), followed by PPS with NKF (21.4%) and TPPP (9.2%).
For type II papilla, in the absence of guidewire placement, NKP was used by 41.1%; with guidewire entry, DGT was most common (58.9%).
For type III papilla, DGT was selected in 48.9% of guidewire-entry cases, while NKP (40.4%) led when no guidewire was used.
For type IV papilla, DGT was favored by 51.8% when the guidewire entered the pancreatic duct; in contrast, 41.8% continued with the standard technique without guidewire use.
Conclusion
Differences emerged based on guidewire placement and papilla type. DGT was preferred when the guidewire entered the pancreatic duct, while NKP was commonly chosen when it did not. These findings suggest that adapting cannulation strategies to papilla morphology may improve procedural success.