title: Clinical significance of the duodenal papilla in patients with separate orifices for the bile and pancreatic ducts.
abstract: BACKGROUND
  There have been few reports of separate orifices (SPO) for the bile and pancreatic ducts. The aim of this study was to elucidate the clinical significance of SPO.
  
  
  METHODS
  Clinical data of patients with SPO (n = 21) were compared with those of 324 patients without SPO. The duodenal papillae in the patients with SPO were classified endoscopically into three types. Furthermore, we compared three subgroups (n = 221) among 345 patients (group A, 10 patients with bile duct stones with SPO; group B, 66 patients with bile duct stones without SPO; and group C, 145 patients without bile duct dysfunction) to evaluate the bile stasis of SPO. Various factors were retrospectively analyzed to identify any relationship in patients with SPO.
  
  
  RESULTS
  Univariate analysis revealed that the diameter of the common bile duct, cholangiographic angulation, and the presence of common bile duct stones (CBDS) were significantly associated with the presence of SPO. Multivariate analysis of the different risk factors for SPO in all patients revealed that the presence of CBDS (relative risk, 3.000; 95% confidence interval, 1.083-8.313; P = 0.0346) and cholangiographic angulation (relative risk, 1.041; 95% confidence interval, 1.010-1.072; P = 0.0085) were independent risk factors. Moreover, univariate analysis among the three subgroups revealed that age, the presence of periampullary diverticula, the diameter of the common bile duct, and the length of the short narrow distal segment were significantly associated with the presence of SPO.
  
  
  CONCLUSIONS
  CBDS and cholangiographic angulation are independent risk factors for SPO. This result suggests that SPO may be associated with an elevated risk of CBDS owing to bile stasis.
authors.affiliation: Division of Gastroenterology, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Atushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000033:anatomy & histology*; D001652:Bile Ducts / Q000033:anatomy & histology*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000033:anatomy & histology*; D012307:Risk Factors