Fiberduodenoscopic Observation on the Dynamics of the Duodenal Papilla

Summary

Through the experience of fiberduodenoscopy, the endoscopic aspects on the dynamics of the duodenal papilla is reported here. Characteristic appearance of the duodenal papilla is hemispherical protrusion on the longitudinal fold associated with proximal preputium-like circular folds and distal frenulum-like longitudinal folds. Color of the papilla varies case by case from reddish to pale, pearly white. The arrangement of the villi on the surface of the papilla seems to be different from surrounding mucosa. The appearance of the papilla is classified into three types; papillar type, hemispherical type and flat type. There may be transition from one type to another in the same case during observation. The accessory papilla can also be detected endoscopically if any. After stimulation with pancreozymin, thick bile flows out of the orifice. The dynamics of bile excretion are reported. During the phase of excretion, a valvular protrusion from inside of the orifice is sometimes observed, which is supposed to be the septum in the ampulla.

Key-Words

Fiberduodenoscopy - main and accessory duodenal papilla - valvular protrusion - dynamics of bile excretion