Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study

United European Gastroenterology Journal
E HaraldssonScandinavian Association for Digestive Endoscopy (SADE) Study Group of Endoscopic Retrograde Cholangio-Pancreaticography


Many 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. The 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. An 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...Continue Reading

Associated Clinical Trials


Mar 1, 1990·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·F BendtsenP Matzen
Feb 24, 2000·The Surgical Clinics of North America·C AvisseJ F Delattre
May 20, 2004·BMC Gastroenterology·Thomas de LangeLars Aabakken
Aug 11, 2007·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Akira HoriuchiNaoki Tanaka
Aug 22, 2007·Scandinavian Journal of Gastroenterology·Anne Mette AsfeldtEyvind J Paulssen
Aug 12, 2009·Endoscopy·Lars AabakkenMasayuki Fujino
Jun 17, 2010·Digestive Surgery·Shin-ichiro Horiguchi, Terumi Kamisawa
Oct 29, 2010·Abdominal Imaging·Zhi-Jun GuoYi-Jun Wang
Apr 20, 2012·Scandinavian Journal of Gastroenterology·J-Matthias LöhrSøren Meisner
Apr 2, 2013·Gastrointestinal Endoscopy Clinics of North America·Yan G Bakman, Martin L Freeman
Apr 20, 2013·World Journal of Gastroenterology : WJG·Andrzej Jamry
Dec 18, 2013·Journal of Gastroenterology and Hepatology·Lars AabakkenJerome D Waye

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