Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

Introduction We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Two new species of Lejeuneaceae tribe Lejeuneeae (Marchantiophyta) from Colombia

We describe the new liverwort species Lejeunea ryszardii from montane rainforest in the Central Cordillera of Colombia (Dept. Quindío) and Rectolejeunea halinae from submontane rainforest in the Western Cordillera (Dept. Risaralda). Both species stand out by copious vegetative reproduction via caducous leaves. Lejeunea ryszardii resembles the Caribbean L. paucidentata in the leaf lobes with toothed margins and a narrow base but strikingly differs from the latter species in: 1) leaf margins with mamillose cells, which are sometimes crowned by a small papilla, and with scattered rhizoids with or without a tooth-like base; 2) lobules with narrowly elongate, curved, sharp tooth; 3) stem epidermis brownish and somewhat thick-walled; 4) copious production of caducous leaf lobes. Moreover, L. ryszardii is dark green to brown in color and probably dioicous while L. paucidentata is light green and autoicous. Rectolejeunea halinae resembles the neotropical R. flagelliformis in having ciliate caducous leaves but clearly differs from the latter in the pointed leaf tips, the presence of ocelli in underleaves, and the flagelliform shoots with flat, entire-margined underleaves. The discovery of these new species adds two further endemic taxa to the rich bryophyte flora of the Colombian Andes.

The first Philippine species of Loeblites Franz (Coleoptera: Staphylinidae: Scydmaeninae)

Loeblites Franz, 1986 is a genus of Glandulariini with adults sharing a very similar body form and most taxonomically important structures with Syndicus Motschulsky, 1851. One of the most conspicuous differences between these genera is the antennal structure. In Syndicus, the antennomere XI is strongly reduced, much shorter than X and lacks the basal stalk, so that the two terminal antennomeres are compactly assembled. They either form one oval structure that appears as a single antennomere because the base of subconical antennomere XI is as broad as apex of X (Syndicus s. str.) or the antennomere XI forms a distinct small 'papilla' on top of X (subgen. Semisyndicus Jałoszyński, 2004) because the base of antennomere XI is much narrower than apex of X. Adults of Loeblites have unmodified antennae, with the antennomere XI strongly elongate and with a narrow basal stalk; additionally the antennae are strikingly slender, nearly filiform. Morphological structures of both genera were described and illustrated by Jałoszyński (2004, 2005). While Syndicus is species-rich, often abundant in leaf litter and under bark in subtropical forests (Jałoszyński 2004, 2006, 2008, 2009, 2011, 2014; Jałoszyński & Nomura 2006; Yin & Li 2015; Yin et al. 2014; Yin & Zhou 2016; Zhou & Yin 2017), and broadly distributed from southeastern Australia, through Southeast Asia, Yunnan (China) and Ryukyus (Japan), up to Sri Lanka, India and the Himalayas, Loeblites comprises merely four species known to occur in Malaysia, Thailand and China (Jałoszyński 2005; Zhou & Li 2015). Loeblites mastigicornis Franz, 1986 is known to occur in Chiang Mai (northern Thailand), L. sabahensis Franz, 1992 and L. minor Jałoszyński, 2005 in Sabah (northern Borneo), and L. chinensis Zhou & Li, 2015 in Yunnan (southwest China). Two females representing an undescribed species were also recorded from Yunnan by Zhou & Li (2015). Specimens of this interesting genus are found rarely, in small numbers and they are typically sifted from leaf litter in subtropical forests.

Aplectana dubrajpuri sp. nov. (Nematoda: Cosmocercidae) in Hoplobatrachus tigerinus (Anura: Dicroglossidae) from Dubrajpur, Birbhum, West Bengal, India

Aplectana dubrajpuri sp. nov., recovered from the rectum of Indian bull frog, Hoplobatrachus tigerinus, collected from Dubrajpur in the Birbhum district of West Bengal, India, is described and illustrated. This species is characterised by absence of gubernaculum and differs from other species of Aplectana which lack a gubernaculum (viz. A. akhrami, A. artigasi, A. chilensis, A. crossodactyli, A. crucifer, A. delirae, A. meridionalis, A. papillifera, A. praeputialis, A. tarija and A. vercammeni) by smaller size of males and females, absence of somatic papillae in females and number and distribution of caudal papillae in males which include 3 pairs precloacal, 1 pair adcloacal, 14 pairs postcloacal and a single unpaired small papilla on the upper lip of cloaca. Aplectana dubrajpuri sp. nov. represents 51

Ways to improve quality of endoscopic sphincterotomy in difficult technic cases

During examining endoscopic sphincterotomy difficulties to be discovered that the small papilla of Vater cause technological problems of identification common bile duct orice. The best way to overcame that difficulties is performing of of hepar bile ductes punction with endoscopic common bile duct orice identification.