Clinical significance of the duodenal papilla in patients with separate orifices for the bile and pancreatic ducts.

BACKGROUND

There have been few reports of separate orifices (SPO) for the bile and pancreatic ducts. The aim of this study was to elucidate the clinical significance of SPO.

METHODS

Clinical data of patients with SPO (n = 21) were compared with those of 324 patients without SPO. The duodenal papillae in the patients with SPO were classified endoscopically into three types. Furthermore, we compared three subgroups (n = 221) among 345 patients (group A, 10 patients with bile duct stones with SPO; group B, 66 patients with bile duct stones without SPO; and group C, 145 patients without bile duct dysfunction) to evaluate the bile stasis of SPO. Various factors were retrospectively analyzed to identify any relationship in patients with SPO.

RESULTS

Univariate analysis revealed that the diameter of the common bile duct, cholangiographic angulation, and the presence of common bile duct stones (CBDS) were significantly associated with the presence of SPO. Multivariate analysis of the different risk factors for SPO in all patients revealed that the presence of CBDS (relative risk, 3.000; 95% confidence interval, 1.083-8.313; P = 0.0346) and cholangiographic angulation (relative risk, 1.041; 95% confidence interval, 1.010-1.072; P = 0.0085) were independent risk factors. Moreover, univariate analysis among the three subgroups revealed that age, the presence of periampullary diverticula, the diameter of the common bile duct, and the length of the short narrow distal segment were significantly associated with the presence of SPO.

CONCLUSIONS

CBDS and cholangiographic angulation are independent risk factors for SPO. This result suggests that SPO may be associated with an elevated risk of CBDS owing to bile stasis.