THE USE OF THE FORCEPS BIOPSY AS AN AUXILIARY TECHNIQUE FOR THE VISUALIZATION OF THE MAJOR DUODENAL PAPILLA USING THE FOWARD-VIEWING UPPER ENDOSCOPY

- Conventional esophagogastroduodenoscopy is the best method for evaluation of the upper gastrointestinal tract, but it has limitations for the identification of the major duodenal papilla, even after the use of the straightening maneuver. Side-viewing duodenoscope is recommended for optimal examina...

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Published in:	Arquivos de gastroenterologia Vol. 55; no. 1; pp. 46 - 49
Main Authors:	Andrade, Nathalia Saber de, André, Ana Maria Félix, Ferreira, Victor Hugo Perches, Ferreira, Lincoln Eduardo Villela Vieira de Castro
Format:	Journal Article
Language:	English
Published:	Brazil Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE 01-01-2018 Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia (IBEPEGE)
Subjects:	Adenocarcinoma, diagnostic Ampulla of Vater, physiopathology Digestive system endoscopy, utilization GASTROENTEROLOGY & HEPATOLOGY Ampulla of Vater, physiopathology Adenocarcinoma, diagnóstico Digestive system endoscopy, utilization Adenocarcinoma, diagnostic Endoscopia do sistema digestório, utilização Ampola hepatopancreática, fisiopatologia
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Summary:	- Conventional esophagogastroduodenoscopy is the best method for evaluation of the upper gastrointestinal tract, but it has limitations for the identification of the major duodenal papilla, even after the use of the straightening maneuver. Side-viewing duodenoscope is recommended for optimal examination of major duodenal papilla in patients at high risk for lesions in this region. To evaluate the use of the biopsy forceps during conventional esophagogastroduodenoscopy as an additional tool to the straightening maneuver, in the evaluation of the major duodenal papilla. A total of 671 patients were studied between 2013 and 2015, with active major duodenal papilla search in three endoscope steps: not straightened, straightened and use of the biopsy forceps after straightening. In all of them it was recorded whether: major duodenal papilla was fully visualized (position A), partially visualized (position B) or not visualized (position C). If major duodenal papilla was not fully visualized, patients continued to the next step. A total of 341 were female (50.8%) with mean age of 49 years. Of the 671 patients, 324 (48.3%) major duodenal papilla was identified in position A, 112 (16.7%) in position B and 235 (35%) in position C. In the 347 patients who underwent the straightening maneuver, position A was found in 186 (53.6%), position B in 51 (14.7%) and position C in 110 (31.7%). Of the 161 remaining patients and after biopsy forceps use, position A was seen in 94 (58.4%), position B in 14 (8.7%) and position C in 53 (32.9%). The overall rate of complete visualization of major duodenal papilla was 90%. The use of the biopsy forceps significantly increased the total major duodenal papilla visualization rate by 14%, reaching 604/671 (90%) of the patients (P<0.01) and it can be easily incorporated into the routine endoscopic examination of the upper gastrointestinal tract.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0004-2803 1678-4219 1678-4219
DOI:	10.1590/s0004-2803.201800000-04