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April 1974

Endoscopic Cannulation of the Papilla of Vater

Arch Surg. 1974;108(4):519-525. doi:10.1001/archsurg.1974.01350280121020

The first 65 attempts at cannulation of the papilla of Vater via the duodenal fiberendoscope were successful in 62 (95%) patients with the desired duct demonstrated in 57 (92%) patients. Of 62 successful cannulations, 12 patients had selective pancreatography, 13 had selective cholangiography, and 37 had combined cholangiopancreatography. Pathological findings included pancreatic carcinoma, pancreatitis, gallstones, common duct stones, and biliary ductal carcinoma. In 17 jaundiced patients, nine normal cholangiograms were obtained that avoided surgical exploration. In 14 patients, gastroduodenoscopy at the time of cannulation revealed significant mucosal pathological findings pertinent to the patient's symptoms. No significant complications occurred in any patients.

Endoscopic cannulation of the papilla of Vater is proving to be a valuable, practical, low-risk procedure that can significantly increase diagnostic accuracy in biliary-pancreatic disease and that helps avoid the risk, discomfort, and inconvenience of surgical exploration in a substantial number of patients.