Anatomical Variations of the Major Duodenal Papilla in a Select Adult Population

Background: The appearance of the major duodenal papilla (MDP) has ethnic variations that determine the ease of cannulation during endoscopic retrograde cholangiopancreatography. Understanding its variant anatomy may help ensure safety during surgical procedures around the duodenum. Materials and Methods: This observational cross-sectional study examined 140 adult specimens with intact MDP obtained from nairobi funeral home, university of nairobi-chiromo funeral parlour, and kenyatta national hospital farewell home following ethical approval granted by the institutional ethics and research committee. The morphology of the MDP was classified as protruded, flat, and depressed, and its distance from the pylorus, transverse diameter, and the protruded papilla’s longitudinal measurements were taken. Data were analyzed using SPSS (Version 27.0). Means and standard deviations were calculated. Results were represented with tables. Results: The morphology of the MDP was identified as protruded (69.29%), flat (19.29%), and depressed (11.43%). Among protruded papilla, small protrusion was (17%), regular protrusion (80%), and large protrusion (3%). The mean distance from the pylorus was 90.23 ± 23.39 mm. The mean transverse diameter of the papillae was 6.88 ± 3.13 mm, and the mean longitudinal protrusion length of the protruded papillae was 5.93 ± 2.84 mm. The One-way ANOVA statistical test found that older individuals (59 + years) had a statistically significant shorter distance of the MDP from the pylorus ( P = 0.018). Conclusion: Since the anatomic location, morphology, and morphometry of the MDP showed inter-individual and inter-population variation, we recommend that endoscopists operating in the region of the MDP thoroughly investigate the papilla and use its morphology as a guide for the technique of canulation.