(Open access funding provided by Semmelweis University)
Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary therapeutic procedure
for pancreaticobiliary disorders, and studies highlighted the impact of papilla anatomy
on its efficacy and safety. Our objective was to quantify the influence of papilla
morphology on ERCP outcomes. We systematically searched three medical databases in
September 2022, focusing on studies detailing the cannulation process or the rate
of adverse events in the context of papilla morphology. The Haraldsson classification
served as the primary system for papilla morphology, and a pooled event rate with
a 95% confidence interval was calculated as the effect size measure. Out of 17 eligible
studies, 14 were included in the quantitative synthesis. In studies using the Haraldsson
classification, the rate of difficult cannulation was the lowest in type I papilla
(26%), while the highest one was observed in the case of type IV papilla (41%). For
post-ERCP pancreatitis, the event rate was the highest in type II papilla (11%) and
the lowest in type I and III papilla (6-6%). No significant difference was observed
in the cannulation failure and post-ERCP bleeding event rates between the papilla
types. In conclusion, certain papilla morphologies are associated with a higher rate
of difficult cannulation and post-ERCP pancreatitis.
