Diagnostic significance of a dilated orifice of the duodenal papilla in intraductal papillary mucinous neoplasm of the pancreas

Background: A dilated orifice of the duodenal papilla found during screening endoscopy or ERCP is well-known as one of the specific findings of intraductal papillary mucinous neoplasm (IPMN). However, its clinical significance is still unclear. Objective: To assess the diagnostic significance of a dilated orifice of the duodenal papilla and evaluate whether this could be a factor predictive of malignancy or a subtype of IPMN. Design: Retrospective study. Setting: University hospital. Patients: This study involved 149 patients who underwent pancreatectomy for IPMN between January 1987 and June 2011. Intervention: ERCP. Main Outcome Measurements: The rate of malignant and intestinal type IPMNs in patients with and without papillary dilation. Results: A dilated orifice of the duodenal papilla was significantly associated with intestinal type IPMN (P < .001), but this finding could not predict the malignant grade of IPMN (P = .13). Multivariate analysis revealed that a dilated orifice was a significant factor for predicting intestinal type in both main duct (P = .01) and branch duct IPMNs (P < .001). Limitations: The validity of the definition of papillary dilation, selection bias, and a retrospective study. Conclusion: A dilated orifice of the duodenal papilla could be a significant factor for predicting intestinal type IPMN. This may lead to better clinical management of patients with IPMN. (Gastrointest Endosc 2012;76:313-20.)