ArticleUnited European gastroenterology journal2017
Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study.
Article in United European gastroenterology journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 39 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Influence of Vater's Ampulla Morphology on Biliary Cannulation Rate, Complications and Advanced Biliary Cannulation Techniques
Needle Knife Fistulotomy Versus Partial Ampullary Endoscopic Mucosal Resection for Difficult Biliary Cannulation
SOCCER: Study Of forCeps Cannulation During ERcp
Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Morphology of the papilla can predict procedural safety and efficacy of ERCP-a systematic review and meta-analysis.Scientific reports · 2024Pooled it
- A Randomized Controlled Trial of Patient Positioning During Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures: A Comparison Between Semi-Prone- and Prone-Positioned Patients.Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and AssociatesTrial
- Papillary Balloon Dilation Versus Sphincterotomy for Small Common Bile Duct Stones: Recurrence and Pneumobilia in a Retrospective Cohort.Digestive diseases and sciences · 2026Article
- Endoscopic Appearance After Transpancreatic Precut Sphincterotomy: Classification and Implications for Biliary Cannulation.Journal of clinical medicine · 2026Article
- AI-Based Prediction of Post-ERCP Pancreatitis: A Comparative Study Using Tabular, Image, and Multimodal Data.Diagnostics (Basel, Switzerland) · 2026Article
- Superiority of Pancreatic Duct Stent-Assisted Biliary Cannulation for Difficult Biliary Cannulation During Endoscopic Retrograde Cholangiopancreatography After Unintentional Pancreatic Duct Access.Surgical laparoscopy, endoscopy & percutaneous techniques · 2026Article
- Digital Cholangioscopy-Based Radiation-Free Management of Choledocholithiasis: A Retrospective Cohort Study.Digestive diseases and sciences · 2026Article
- Difficult biliary cannulation during ERCP: techniques and an evidence-informed practical algorithm.Frontiers in medicine · 2026Review
- Advanced Biliary Cannulation Masterclasses Improve Self-reported Knowledge and Teaching Confidence in Needle-knife Fistulotomy.Endoscopy international open · 2026Article
- The guidewire-guided endoscopic retrograde direct cholangioscopy facilitating the difficult biliary cannulation of small papilla.Endoscopy · 2025Article
- Impact of Papillary Morphology and Diverticular Type on Needle-Knife Papillotomy in Patients with Periampullary Diverticulum with Difficult Biliary Cannulation.Journal of clinical medicine · 2025Article
- Tip palpation of the intraduodenal biliary segment for needle-knife fistulotomy.VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy · 2025Review
- Prophylactic Biliary Stenting After Stone Clearance Improves the Safety of Needle-Knife Fistulotomy: A Propensity Score-Matched Analysis.JGH open : an open access journal of gastroenterology and hepatology · 2025Article
- Rescue cannulation techniques in difficult biliary access-A comprehensive review.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2025Review
- Efficacy of e-learning using video content in improving trainees' biliary cannulation skills and understanding (with video).DEN open · 2025Article
- Long-term prognosis and risk factors associated with 30-day unplanned repeated ERCP in patients with common bile duct stones.Therapeutic advances in gastroenterology · 2025Article
- Optimal timing for discontinuation of ERCP in cases of difficult selective biliary cannulation.Endoscopy international open · 2025Article
- Impact of major duodenal papilla morphology on the outcomes of primary needle-knife fistulotomy for deep biliary cannulation.Scientific reports · 2024Article
- Relationship of difficult endoscopic retrograde cholangiopancreatography cannulation and visual characteristics of papilla.JGH open : an open access journal of gastroenterology and hepatology · 2024Article
- Impact of Duodenal Papilla Morphology on the Success of Transpancreatic Precut Sphincterotomy.Journal of clinical medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMany endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla.
objectiveThe purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience.
methodsAn endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, 'classic appearance'; (b) Type 2: small papilla, often flat, with a diameter ≤ 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists.
resultsInterobserver agreement was substantial (κ = 0.62, 95% confidence interval (CI) 0.58-0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (κ = 0.66, 95% CI 0.59-0.72).
conclusionThe proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter- and intraobserver agreement and now the clinical relevance of the four different papilla types awaits to be determined.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.