[Vascularization of the Papilla Vateri and bleeding risk of papillotomy (author's transl)].

The vascularization of the Papilla Vateri was investigated by angiography, histology and morphometry in 55 samples obtained at autopsy; four main types may be distinguished. The bleeding risk accompanying endoscopic papillotomy in general is low because of the anatomy of the arterial supply of the papilla. The average diameter of the vessels in the plexus arteriosus papillae is about 0,98 mm, it is only 0,43 mm in the proximal part of the papilla (that is to say, the part adhering to the bile duct). The arteria retroduodenalis crosses the ductus choledochus on the average 37.5 mm from the tip of the papilla. In rare cases more excessive arterial bleeding may occur, since there is a crossing of the arteria retroduodenalis through the region of papillotomy in about 4% of the cases. A high bleeding risk exists during 8 days after the first of a multiple step papillotomy procedure, since during this period vascularization of the granulating tissue is still extensive.