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BACKGROUND: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. OBJECTIVE: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. METHODS: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, 'classic appearance'; (b) Type 2: small papilla, often flat, with a diameter ≤ 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists. RESULTS: Interobserver agreement was substantial (κ = 0.62, 95% confidence interval (CI) 0.58-0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (κ = 0.66, 95% CI 0.59-0.72). CONCLUSION: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter- and intraobserver agreement and

The study was carried out on the material of 327 pathoanatomical autopsies taking into account the sex, age, clinical data, pathoanatomical, and clinical diagnoses. The material is divided into two groups: The 1st group - without an ectopic pancreatic tissue in the major duodenum papilla (279 cases) and the 2nd group - with different variants of ectopic pancreatic tissue (48 cases). In each of them, the distribution was carried out according to sex, age, and cause of death

The anatomical, morphometrical, histological and immunohistochemical studies of the major duodenal papilla were performed on the materials of 327 autopsy cases. The pancreatic heterotopia was revealed in 14,7% cases. This abnormality was associated with an existence of gallstone disease. More often the heterotopic pancreatic tissue was detected in the medial wall of the major duodenal papilla and its septum. Exocrine, complete and ductular histological variants of pancreatic heterotopia were revealed. The latter existed either as a morphological basis of papillary adenomas with cellular hyperplasia possessing smooth muscle immunophenotype, or as the result of atrophy and sclerosis of the exocrine heterotopic structures