Feasibility of forward-viewing upper endoscopy for detection of the major duodenal papilla

The purpose of this study was to assess the feasibility of forward-viewing upper endoscopy for detection of the major duodenal papilla (MDP) as an indicator of the descending duodenum.

A total of 338 patients were prospectively enrolled. Upper endoscopy was first performed by a routine method for all patients, and a subsequent straightening endoscopic technique, straightening the loop by withdrawal of the scope, was performed if the MDP was not identified during the routine method.

Findings of MDP observation using the upper endoscope could be categorized into five types: Type I, whole area of the papilla; Type II, upper part of the papilla, including the orifice; Type III, upper part of the papilla without the orifice; Type IV, lower part of the papilla, including the orifice; Type V, no part of the papilla was found. Upper endoscopy by a routine method detected the MDP in whole or in part in 194 patients (57.4%). Among 144 patients whose MDP could not be detected by use of a routine method, the MDP was identified by a subsequent straightening endoscopic technique in 108 patients (75.0%). Overall rate of observation of the MDP during full upper endoscopy was 89.3% (302/338). Type I is the most frequent (n = 185, 54.7%), followed by Type IV (n = 73, 21.6%), Type II (n = 23, 6.8%), and Type III (n = 21, 6.2%), in that order.

Our results support the value of forward-viewing endoscopy in observation of the MDP. Use of a straightening endoscopic technique, in particular, increases in the rate of detection of the MDP.