Document Detail


The arterial supply of the major duodenal papilla and its relevance to endoscopic sphincterotomy.
MedLine Citation:
PMID:  21455871     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIMS: Arterial bleeding from the major duodenal papilla is an uncommon but potentially life-threatening complication of endoscopic sphincterotomy. We investigated the arterial blood supply of the papilla to determine whether there might be a safer region for sphincterotomy.
METHODS: Arteries supplying the major duodenal papilla were studied in 19 cadaver pancreaticoduodenal specimens (nine male, mean age 81 years, range 64 - 97 years) using a combination of microdissection and histology. The number, origin, caliber, and distribution of arteries within 5 mm of the major duodenal papilla were recorded.
RESULTS: A total of 98 papillary arteries were identified by microdissection giving a mean of 5.2 arteries (range 3 - 9) per specimen. Papillary arteries originated from three sources: communicating arteries and the posterior and anterior pancreaticoduodenal arcade arteries. The majority of arteries were related to the antero-superior and postero-inferior quadrants of the major duodenal papilla, both at their point of entry into the duodenal wall or bile/pancreatic ducts (microdissection) and in their distribution 5 mm from the tip of the papilla (histology). The combined 10 and 11 o'clock segments of the papilla (as viewed endoscopically) contained only 10 % and 11 % of all papillary arteries on microdissection and histology, respectively, with seven of 19 specimens having no arteries in this region.
CONCLUSIONS: This study documents for the first time the distribution of papillary arteries around the circumference of the major duodenal papilla. Arterial bleeding complicating endoscopic sphincterotomy might be reduced by incising the papilla in the 10 - 11 o'clock region rather than the currently recommended 11 - 1 o'clock position.
Authors:
S A Mirjalili; M D Stringer
Publication Detail:
Type:  Journal Article     Date:  2011-03-31
Journal Detail:
Title:  Endoscopy     Volume:  43     ISSN:  1438-8812     ISO Abbreviation:  Endoscopy     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  307-11     Citation Subset:  IM    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Affiliation:
Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
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