<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04492124</url>
  </required_header>
  <id_info>
    <org_study_id>30/2020</org_study_id>
    <nct_id>NCT04492124</nct_id>
  </id_info>
  <brief_title>Influence of Vater's Ampulla Morphology on ERCP</brief_title>
  <official_title>Influence of Vater's Ampulla Morphology on Biliary Cannulation Rate, Complications and Advanced Biliary Cannulation Techniques</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Minho</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Unidade Local de Saúde do Alto Minho</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Minho</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Determine the influence of the papilla's morphology on the various outcomes of endoscopic&#xD;
      retrograde cholangiopancreatography (ERCP), namely on the success of biliary cannulation, on&#xD;
      complications, and on the need to use rescue cannulation techniques;&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      1. Background&#xD;
&#xD;
           ERCP is an advanced procedure which is widely used in the diagnosis and treatment of a&#xD;
           variety of benign and malignant pancreatobiliary disorders1,2,3,4,5.&#xD;
&#xD;
           Selective cannulation of the common bile duct (CBD) is the most important and&#xD;
           challenging step in a biliary endoscopic retrograde cholangiopancreatography6,7.&#xD;
           However, in the first ERCP, even in experienced hands, biliary cannulation may fail in&#xD;
           up to 15 % - 35 % of cases when using standard methods alone8.&#xD;
&#xD;
           Since the first description of the &quot;Vater's papilla&quot; by Abraham Vater in 17209, the&#xD;
           variability in papillary morphology has been widely recognized10. The use of high&#xD;
           quality digital images has led to a clear need and desire to create an endoscopic&#xD;
           classification based on the papilla's morphology. During the last decade, several&#xD;
           authors have proposed different classifications in order to predict the success of&#xD;
           cannulation, complications and the need for more advanced cannulation&#xD;
           techniques11,12,13,14,15. However, all the proposed classifications, with the exception&#xD;
           of one, fail because they have not been submitted to a validation process. The only&#xD;
           validated one is the proposed by Haraldsson13, which still has the drawback of not&#xD;
           incorporating some of the papillary morphologies.&#xD;
&#xD;
           Given the need, our research group created a new classification (entitled &quot;Viana&#xD;
           Classification&quot;) that not only incorporates more morphologies but was also validated in&#xD;
           due course.&#xD;
&#xD;
           Hence, the next step is to explore the potential implications of papillary morphology on&#xD;
           the success of biliary cannulation, complications resulting from ERCP and the need to&#xD;
           use rescue techniques (fistulotomy and double-guidewire cannulation) in the event of&#xD;
           failure of the standard cannulation.&#xD;
&#xD;
        2. Financial resources&#xD;
&#xD;
           All participants included in this study will perform ERCP, laboratory tests and other&#xD;
           complementary diagnostic tests after a duly justified medical prescription (the exact&#xD;
           same exams that the patient would do if there wasn't this study). Therefore, there are&#xD;
           no additional costs or consumption of hospital resources.&#xD;
&#xD;
        3. Ethical considerations&#xD;
&#xD;
           In this study, participants will be included after informed consent. Anonymity and&#xD;
           confidentiality will be safeguarded by assigning an individual numeric code. It will&#xD;
           also be explained the possibility of withdrawing from the study at any time, with the&#xD;
           guarantee of the total elimination of data. All researchers involved in the study will&#xD;
           adhere to the Rules of Ethical Conduct and Best Practices in order to comply with the&#xD;
           precepts of the Declaration of Helsinki, the Convention on Human Rights and Biomedicine,&#xD;
           the guidelines of the Council for International Organizations of Medical Sciences and&#xD;
           the Guide to Good Clinical Practice.&#xD;
&#xD;
        4. Statistical analysis&#xD;
&#xD;
           Qualitative variables will be summarized using absolute and relative frequencies, and&#xD;
           quantitative variables will be summarized using the mean and standard deviation or the&#xD;
           median and interquartile range, depending on their distribution profiles. The normality&#xD;
           of the quantitative variables will be assessed using the histogram distribution.&#xD;
&#xD;
           Relations between categorical variables will be assessed using a chi-square test and&#xD;
           Fisher´s exact test. Differences between two or more groups of independent non-normally&#xD;
           distributed quantitative variables will be evaluated using a Kruskal-Wallis test.&#xD;
&#xD;
           To explain the risk of pancreatitis, a binomial logistic regression model with multiple&#xD;
           predictors will be performed.&#xD;
&#xD;
           The null hypothesis will be rejected when the test statistics p-values are less than&#xD;
           &lt;0.05. Statistical analysis, sample size calculation and graphics will be performed&#xD;
           using Stata software (StataCorp. 2015. Stata Statistical Software: Release 14. College&#xD;
           Station, StataCorp LP)&#xD;
&#xD;
        5. Expected results&#xD;
&#xD;
      The results from this study will contribute to a better understanding of the influence of&#xD;
      papillary morphology on cannulation difficulty. In the event of demonstrating that some&#xD;
      morphologies imply greater difficulty in cannulation, strategies may be created, such as the&#xD;
      use of ab initio rescue techniques, in order to improve the results of ERCP, namely the&#xD;
      cannulation rate.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Recruiting</last_known_status>
  <start_date type="Actual">June 1, 2020</start_date>
  <completion_date type="Anticipated">June 1, 2022</completion_date>
  <primary_completion_date type="Anticipated">June 1, 2022</primary_completion_date>
  <study_type>Observational [Patient Registry]</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <target_duration>30 Days</target_duration>
  <primary_outcome>
    <measure>Correlation between the morphology of the Vater's Ampulla and biliary cannulation difficulty</measure>
    <time_frame>1 day</time_frame>
    <description>Correlation between the morphology of the Papilla de Vater, defined by the Viana classification, and the difficulty of cannulation between experts and other endoscopists (initiates and non-expert specialists)</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Correlation between the morphology of the Vater's Ampulla, and complications, and need/success of advanced cannulation techniques</measure>
    <time_frame>up to 30 days</time_frame>
    <description>Correlation between the morphology of the Vater's Ampulla, defined by the Viana classification, and complications, and need/success of advanced cannulation techniques (fistulotomy and double-guidewire cannulation)</description>
  </secondary_outcome>
  <enrollment type="Anticipated">400</enrollment>
  <condition>Pancreatitis</condition>
  <eligibility>
    <study_pop>
      <textblock>
        All individuals referred for CPRE in the Digestive Endoscopy Unit of the Santa Luzia&#xD;
        Hospital, Unidade Local de Saúde do Alto Minho, will be invited to participate in the&#xD;
        study, in the period between June 1, 2020 to June 1, 2022.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Probability Sample</sampling_method>
    <criteria>
      <textblock>
        We will conduct a prospective observational study.&#xD;
&#xD;
        Inclusion Criteria:&#xD;
&#xD;
          -  ERCP with indication for biliary access&#xD;
&#xD;
          -  Naïve papilla&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patients unable to understand the informed consent&#xD;
&#xD;
          -  Patients with surgically altered anatomy&#xD;
&#xD;
          -  Patients with tumors of the papilla&#xD;
&#xD;
          -  Previous sphincterotomy&#xD;
&#xD;
          -  Spontaneous papillary fistula&#xD;
&#xD;
          -  Papilla not visualized&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
  </eligibility>
  <overall_contact>
    <last_name>Luís Lopes, MD, PhD, MBA</last_name>
    <phone>+351932841974</phone>
    <email>luis.m.lopes@me.com</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>João Pedro Sousa Silva R Fernandes, MD</last_name>
    <phone>+351960315790</phone>
    <email>jotillfernandes@hotmail.com</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Santa Luzia Hospital, Unidade Local de Saúde do Alto Minho</name>
      <address>
        <city>Viana do Castelo</city>
        <zip>4904-858</zip>
        <country>Portugal</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Luís Lopes</last_name>
      <phone>+351938241974</phone>
      <email>luis.m.lopes@me.com</email>
    </contact>
    <contact_backup>
      <last_name>João Fernandes</last_name>
      <phone>+351960315790</phone>
      <email>jotillfernandes@hotmail.com</email>
    </contact_backup>
  </location>
  <location_countries>
    <country>Portugal</country>
  </location_countries>
  <reference>
    <citation>Canena J, Liberato M, Coutinho AP, Marques I, Romao C, Veiga PM, Neves BC. Predictive value of cholangioscopy after endoscopic management of early postcholecystectomy bile duct strictures with an increasing number of plastic stents: a prospective study (with videos). Gastrointest Endosc. 2014 Feb;79(2):279-88. doi: 10.1016/j.gie.2013.07.022. Epub 2013 Sep 5.</citation>
    <PMID>24012251</PMID>
  </reference>
  <reference>
    <citation>Canena J, Coimbra J, Carvalho D, Rodrigues C, Silva M, Costa M, Horta D, Mateus Dias A, Seves I, Ramos G, Ricardo L, Coutinho AP, Romao C, Veiga PM. Endoscopic bilio-duodenal bypass: outcomes of primary and revision efficacy of combined metallic stents in malignant duodenal and biliary obstructions. Dig Dis Sci. 2014 Nov;59(11):2779-89. doi: 10.1007/s10620-014-3199-y. Epub 2014 May 13.</citation>
    <PMID>24821464</PMID>
  </reference>
  <reference>
    <citation>Canena J, Liberato M, Meireles L, Marques I, Romao C, Coutinho AP, Neves BC, Veiga PM. A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos). Gastrointest Endosc. 2015 Jul;82(1):70-8. doi: 10.1016/j.gie.2014.11.038. Epub 2015 Mar 11.</citation>
    <PMID>25771064</PMID>
  </reference>
  <reference>
    <citation>Canena J. Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare? GE Port J Gastroenterol. 2018 Jan;25(1):6-9. doi: 10.1159/000481688. Epub 2017 Nov 8. No abstract available.</citation>
    <PMID>29457044</PMID>
  </reference>
  <reference>
    <citation>Canena J, Lopes L, Fernandes J, Alexandrino G, Lourenco L, Libanio D, Horta D, Giestas S, Reis J. Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones. GE Port J Gastroenterol. 2019 Mar;26(2):105-113. doi: 10.1159/000488508. Epub 2018 May 16.</citation>
    <PMID>30976615</PMID>
  </reference>
  <reference>
    <citation>Lopes L, Dinis-Ribeiro M, Rolanda C. Safety and efficacy of precut needle-knife fistulotomy. Scand J Gastroenterol. 2014 Jun;49(6):759-65. doi: 10.3109/00365521.2014.898085. Epub 2014 Mar 18.</citation>
    <PMID>24641260</PMID>
  </reference>
  <reference>
    <citation>Testoni PA, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, Deviere J, Dinis-Ribeiro M, Dumonceau JM, Giovannini M, Gyokeres T, Hafner M, Halttunen J, Hassan C, Lopes L, Papanikolaou IS, Tham TC, Tringali A, van Hooft J, Williams EJ. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 Jul;48(7):657-83. doi: 10.1055/s-0042-108641. Epub 2016 Jun 14.</citation>
    <PMID>27299638</PMID>
  </reference>
  <reference>
    <citation>Testoni PA, Testoni S, Giussani A. Difficult biliary cannulation during ERCP: how to facilitate biliary access and minimize the risk of post-ERCP pancreatitis. Dig Liver Dis. 2011 Aug;43(8):596-603. doi: 10.1016/j.dld.2011.01.019. Epub 2011 Mar 4.</citation>
    <PMID>21377432</PMID>
  </reference>
  <reference>
    <citation>Lerch MM, Domschke W. Abraham Vater of the ampulla (papilla) of Vater. Gastroenterology. 2000 Feb;118(2):379. doi: 10.1016/s0016-5085(00)70243-5. No abstract available.</citation>
    <PMID>10691372</PMID>
  </reference>
  <reference>
    <citation>Vater A. Dissertatio anatomica quo novum bilis dicetilicum circa orifucum ductus choledochi ut et valvulosam colli vesicæ felleæ constructionem ad disceptandum proponit. Wittenberg 1720</citation>
  </reference>
  <reference>
    <citation>Horiuchi A, Nakayama Y, Kajiyama M, Tanaka N. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla. Clin Gastroenterol Hepatol. 2007 Sep;5(9):1113-8. doi: 10.1016/j.cgh.2007.05.014. Epub 2007 Aug 6.</citation>
    <PMID>17689295</PMID>
  </reference>
  <reference>
    <citation>Lee TH, Bang BW, Park SH, Jeong S, Lee DH, Kim SJ. Precut fistulotomy for difficult biliary cannulation: is it a risky preference in relation to the experience of an endoscopist? Dig Dis Sci. 2011 Jun;56(6):1896-903. doi: 10.1007/s10620-010-1483-z. Epub 2010 Nov 17.</citation>
    <PMID>21082346</PMID>
  </reference>
  <reference>
    <citation>Haraldsson E, Lundell L, Swahn F, Enochsson L, Lohr JM, Arnelo U; Scandinavian Association for Digestive Endoscopy (SADE) Study Group of Endoscopic Retrograde Cholangio-Pancreaticography. Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study. United European Gastroenterol J. 2017 Jun;5(4):504-510. doi: 10.1177/2050640616674837. Epub 2016 Oct 17.</citation>
    <PMID>28588881</PMID>
  </reference>
  <reference>
    <citation>Haraldsson E, Kylanpaa L, Gronroos J, Saarela A, Toth E, Qvigstad G, Hult M, Lindstrom O, Laine S, Karjula H, Hauge T, Sadik R, Arnelo U. Macroscopic appearance of the major duodenal papilla influences bile duct cannulation: a prospective multicenter study by the Scandinavian Association for Digestive Endoscopy Study Group for ERCP. Gastrointest Endosc. 2019 Dec;90(6):957-963. doi: 10.1016/j.gie.2019.07.014. Epub 2019 Jul 18.</citation>
    <PMID>31326385</PMID>
  </reference>
  <reference>
    <citation>Watanabe M, Okuwaki K, Kida M, Imaizumi H, Yamauchi H, Kaneko T, Iwai T, Hasegawa R, Miyata E, Masutani H, Tadehara M, Adachi K, Koizumi W. Transpapillary Biliary Cannulation is Difficult in Cases with Large Oral Protrusion of the Duodenal Papilla. Dig Dis Sci. 2019 Aug;64(8):2291-2299. doi: 10.1007/s10620-019-05510-z. Epub 2019 Feb 12.</citation>
    <PMID>30746630</PMID>
  </reference>
  <verification_date>July 2020</verification_date>
  <study_first_submitted>July 9, 2020</study_first_submitted>
  <study_first_submitted_qc>July 26, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 30, 2020</study_first_posted>
  <last_update_submitted>July 26, 2020</last_update_submitted>
  <last_update_submitted_qc>July 26, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">July 30, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University of Minho</investigator_affiliation>
    <investigator_full_name>Luis Lopes</investigator_full_name>
    <investigator_title>Assistant Professor University of Minho, School of Medicine</investigator_title>
  </responsible_party>
  <keyword>Vater's ampulla</keyword>
  <keyword>Major Papilla</keyword>
  <keyword>ERCP</keyword>
  <keyword>Biliary cannulation</keyword>
  <keyword>Precut</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Pancreatitis</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04492124
org study id: 30/2020
nct id: NCT04492124
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Determine the influence of the papilla's morphology on the various outcomes of endoscopic
      retrograde cholangiopancreatography (ERCP), namely on the success of biliary cannulation, on
      complications, and on the need to use rescue cannulation techniques;
1. Background

           ERCP is an advanced procedure which is widely used in the diagnosis and treatment of a
           variety of benign and malignant pancreatobiliary disorders1,2,3,4,5.

           Selective cannulation of the common bile duct (CBD) is the most important and
           challenging step in a biliary endoscopic retrograde cholangiopancreatography6,7.
           However, in the first ERCP, even in experienced hands, biliary cannulation may fail in
           up to 15 % - 35 % of cases when using standard methods alone8.

           Since the first description of the "Vater's papilla" by Abraham Vater in 17209, the
           variability in papillary morphology has been widely recognized10. The use of high
           quality digital images has led to a clear need and desire to create an endoscopic
           classification based on the papilla's morphology. During the last decade, several
           authors have proposed different classifications in order to predict the success of
           cannulation, complications and the need for more advanced cannulation
           techniques11,12,13,14,15. However, all the proposed classifications, with the exception
           of one, fail because they have not been submitted to a validation process. The only
           validated one is the proposed by Haraldsson13, which still has the drawback of not
           incorporating some of the papillary morphologies.

           Given the need, our research group created a new classification (entitled "Viana
           Classification") that not only incorporates more morphologies but was also validated in
           due course.

           Hence, the next step is to explore the potential implications of papillary morphology on
           the success of biliary cannulation, complications resulting from ERCP and the need to
           use rescue techniques (fistulotomy and double-guidewire cannulation) in the event of
           failure of the standard cannulation.

        2. Financial resources

           All participants included in this study will perform ERCP, laboratory tests and other
           complementary diagnostic tests after a duly justified medical prescription (the exact
           same exams that the patient would do if there wasn't this study). Therefore, there are
           no additional costs or consumption of hospital resources.

        3. Ethical considerations

           In this study, participants will be included after informed consent. Anonymity and
           confidentiality will be safeguarded by assigning an individual numeric code. It will
           also be explained the possibility of withdrawing from the study at any time, with the
           guarantee of the total elimination of data. All researchers involved in the study will
           adhere to the Rules of Ethical Conduct and Best Practices in order to comply with the
           precepts of the Declaration of Helsinki, the Convention on Human Rights and Biomedicine,
           the guidelines of the Council for International Organizations of Medical Sciences and
           the Guide to Good Clinical Practice.

        4. Statistical analysis

           Qualitative variables will be summarized using absolute and relative frequencies, and
           quantitative variables will be summarized using the mean and standard deviation or the
           median and interquartile range, depending on their distribution profiles. The normality
           of the quantitative variables will be assessed using the histogram distribution.

           Relations between categorical variables will be assessed using a chi-square test and
           Fisher´s exact test. Differences between two or more groups of independent non-normally
           distributed quantitative variables will be evaluated using a Kruskal-Wallis test.

           To explain the risk of pancreatitis, a binomial logistic regression model with multiple
           predictors will be performed.

           The null hypothesis will be rejected when the test statistics p-values are less than
           <0.05. Statistical analysis, sample size calculation and graphics will be performed
           using Stata software (StataCorp. 2015. Stata Statistical Software: Release 14. College
           Station, StataCorp LP)

        5. Expected results

      The results from this study will contribute to a better understanding of the influence of
      papillary morphology on cannulation difficulty. In the event of demonstrating that some
      morphologies imply greater difficulty in cannulation, strategies may be created, such as the
      use of ab initio rescue techniques, in order to improve the results of ERCP, namely the
      cannulation rate.
observational model: Cohort
time perspective: Prospective
measure: Correlation between the morphology of the Vater's Ampulla and biliary cannulation difficulty
time frame: 1 day
description: Correlation between the morphology of the Papilla de Vater, defined by the Viana classification, and the difficulty of cannulation between experts and other endoscopists (initiates and non-expert specialists)
measure: Correlation between the morphology of the Vater's Ampulla, and complications, and need/success of advanced cannulation techniques
time frame: up to 30 days
description: Correlation between the morphology of the Vater's Ampulla, defined by the Viana classification, and complications, and need/success of advanced cannulation techniques (fistulotomy and double-guidewire cannulation)
study pop: 
sampling method: Probability Sample
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
last name: Luís Lopes, MD, PhD, MBA
phone: +351932841974
email: luis.m.lopes@me.com
last name: João Pedro Sousa Silva R Fernandes, MD
phone: +351960315790
email: jotillfernandes@hotmail.com
facility: 
status: Recruiting
contact: 
contact backup: 
country: Portugal
citation: Canena J, Liberato M, Coutinho AP, Marques I, Romao C, Veiga PM, Neves BC. Predictive value of cholangioscopy after endoscopic management of early postcholecystectomy bile duct strictures with an increasing number of plastic stents: a prospective study (with videos). Gastrointest Endosc. 2014 Feb;79(2):279-88. doi: 10.1016/j.gie.2013.07.022. Epub 2013 Sep 5.
PMID: 24012251
citation: Canena J, Coimbra J, Carvalho D, Rodrigues C, Silva M, Costa M, Horta D, Mateus Dias A, Seves I, Ramos G, Ricardo L, Coutinho AP, Romao C, Veiga PM. Endoscopic bilio-duodenal bypass: outcomes of primary and revision efficacy of combined metallic stents in malignant duodenal and biliary obstructions. Dig Dis Sci. 2014 Nov;59(11):2779-89. doi: 10.1007/s10620-014-3199-y. Epub 2014 May 13.
PMID: 24821464
citation: Canena J, Liberato M, Meireles L, Marques I, Romao C, Coutinho AP, Neves BC, Veiga PM. A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos). Gastrointest Endosc. 2015 Jul;82(1):70-8. doi: 10.1016/j.gie.2014.11.038. Epub 2015 Mar 11.
PMID: 25771064
citation: Canena J. Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare? GE Port J Gastroenterol. 2018 Jan;25(1):6-9. doi: 10.1159/000481688. Epub 2017 Nov 8. No abstract available.
PMID: 29457044
citation: Canena J, Lopes L, Fernandes J, Alexandrino G, Lourenco L, Libanio D, Horta D, Giestas S, Reis J. Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones. GE Port J Gastroenterol. 2019 Mar;26(2):105-113. doi: 10.1159/000488508. Epub 2018 May 16.
PMID: 30976615
citation: Lopes L, Dinis-Ribeiro M, Rolanda C. Safety and efficacy of precut needle-knife fistulotomy. Scand J Gastroenterol. 2014 Jun;49(6):759-65. doi: 10.3109/00365521.2014.898085. Epub 2014 Mar 18.
PMID: 24641260
citation: Testoni PA, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, Deviere J, Dinis-Ribeiro M, Dumonceau JM, Giovannini M, Gyokeres T, Hafner M, Halttunen J, Hassan C, Lopes L, Papanikolaou IS, Tham TC, Tringali A, van Hooft J, Williams EJ. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 Jul;48(7):657-83. doi: 10.1055/s-0042-108641. Epub 2016 Jun 14.
PMID: 27299638
citation: Testoni PA, Testoni S, Giussani A. Difficult biliary cannulation during ERCP: how to facilitate biliary access and minimize the risk of post-ERCP pancreatitis. Dig Liver Dis. 2011 Aug;43(8):596-603. doi: 10.1016/j.dld.2011.01.019. Epub 2011 Mar 4.
PMID: 21377432
citation: Lerch MM, Domschke W. Abraham Vater of the ampulla (papilla) of Vater. Gastroenterology. 2000 Feb;118(2):379. doi: 10.1016/s0016-5085(00)70243-5. No abstract available.
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responsible party type: Principal Investigator
investigator affiliation: University of Minho
investigator full name: Luis Lopes
investigator title: Assistant Professor University of Minho, School of Medicine
mesh term: Pancreatitis
sharing ipd: No