The rate of endoscopic observation of the major duodenal papilla can be increased by simple guideline

Background: Ampullary lesions are being detected with increased frequency with the growing use of esophagogastroduodenoscopy. However, it is uncertain how frequently endoscopists properly visualize the major papilla in routine clinical practice. This study was undertaken to determine the actual rate of observing the major papilla by endoscopists and if there is a room for improvement in visualizing the duodenal major papilla when performing esophagogastroduodenoscopy.Methods: This was a single-center, prospective, randomized study involving 3,088 consecutive patients referred for diagnostic esophagogastroduodenoscopy at tertiary-care referral center between September and November 2010. Six fellows-in-training in the study group attempted to visualize the major papilla up to three times, while six fellows-in-training in the control group performed endoscopy in a standard fashion.Results: The overall observation rate was significantly higher in study group (975 of 1070 [91.1%]) than in control group (624 of 1022 [61%], p<0.001). “Complete observation” was achieved in 68.2% of the cases in study group compared to 45.0% of the cases in control group (p<0.001). The total procedure time was slightly, but significantly longer in the study group (5.82±2.38 min versus 5.52±2.11 min, p=0.003).Conclusions: The rate of observing the major papilla for endoscopists is not as high as expected in routine clinical practice; however, the rate of observing the major papilla might improve significantly through application of additional effort with but a modest increase in procedural time.