Comparative Analysis Of Two Different Main Duodenal Papilla Morphologies Affecting The Efficacy Of ESBD In The Treatment Of Common Bile Duct Stones

Objective By comparing and analyzing the differences in lithotripsy efficacy and postoperative complications of combined small endoscopic sphincterotomy and balloon dilation in patients with two different main duodenal papilla morphologies.We investigate the effect of two different main duodenal papilla morphologies on the efficiency and safeness of ESBD in the treatment of common bile duct stones.Methods Data were collected from patients with choledocholithiasis who underwent ESBD in general surgery department of the Fourth Affiliated Hospital of Nanchang University from February 2022 to February 2023,The endoscopic classification system of the main duodenal papilla morphology proposed by Haraldsson et al.in2016 was used to classify 114 patients into type I papilla(regular type)and type II papilla(small papilla type)groups.Among them,86 cases in the type I papilla group and 28 cases in the type II papilla group.To compare and analyze the both groups with respect to successful one-time lithotripsy rate,successful intubation rate,difficult intubation rate,mean total operation time,mean lithotripsy time,changes in liver function 24 hours before and after the operation,and postoperative complications.Results There was no statistical difference between the both groups in comparison to baseline data(P > 0.05).There were two failed intubation cases in both groups,and the cannulation success rate was 100% in the type I papilla group and 92.86% in the type II papilla group(26/28).The cannulation success rate was higher in the type I nipple group than in the type II nipple group(P=0.012).The difficult cannulation rate was 16.28%(14/86)in the type I nipple group and 57.69%(15/26)in the type II nipple group,and the difficult cannulation rate was higher in the type II nipple group(P < 0.001).The average cannulation time in the type II nipple group(8.32±3.03 min)was more than type I nipple group(6.03±2.63 min),and the difference was considered statistical significance(P=0.005).The average extraction time in the type II papilla group(10.32±4.47 min)was more than that in the type I papilla group(8.31±3.66 min),and the difference was considered statistical significance(P=0.044).Four patients in the type II papillary group developed mild post-ERCP pancreatitis(PEP),with an incidence of 15.38%,and three patients in the type I nipple group had mild PEP,with an incidence of 3.48%,and no moderate or severe PEP occurred in both groups,and the incidence of PEP was higher in the type II nipple group(P=0.009).There were 5 cases(19.23%)more pancreatic duct stents left in the type II papilla group than 4 cases(4.65%)in the type I papilla group,and the difference was considered statistical significance(P=0.017).In addition,there was no statistical significance difference between the two groups with respect to mean total operative time,change in liver function 24 hours before and after surgery,bleeding,perforation,postoperative biliary tract infection and indwelling nasobiliary tube(P>0.05).There was no statistical significance difference between the two groups with respect to mean total operative time,pre-and postoperative 24-hour liver function changes,bleeding,perforation,postoperative biliary tract infection and indwelling nasobiliary tube(P > 0.05).Conclusion (1)There was no significant difference between ESBD technique in the success rate of one-time lithotripsy and the mean level of change in liver function indexes at24 hours postoperatively between the type I papilla group and the type II papilla group.(2)The type II papilla group had a higher rate of difficult intubation and failed intubation,and longer intubation time and lithotripsy time than the type I papilla group.(3)The incidence of PEP was higher in the type II papillae than in the type I papillae group.