Original ArticlesMajor and Minor Duodenal Papillae in Autoimmune PancreatitisChiba, Kazuro MD; Kamisawa, Terumi MD, PhD; Kuruma, Sawako MD; Iwasaki, Susumu MD; Tabata, Taku MD; Koizumi, Satomi MD; Endo, Yuka MD; Kuwata, Go MD; Fujiwara, Takashi MD; Arakawa, Takeo MD; Koizumi, Koichi MD; Momma, Kumiko MDAuthor Information From the Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. Received for publication November 21, 2013; accepted April 9, 2014. Reprints: Terumi Kamisawa, MD, PhD, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113–8677, Japan (e-mail: [email protected]). This study was supported in part by the Research Committee of Intractable Diseases provided by the Ministry of Health, Labour, and Welfare of Japan. The authors declare no conflict of interest. Pancreas: November 2014 - Volume 43 - Issue 8 - p 1299-1302 doi: 10.1097/MPA.0000000000000191 Buy Metrics Abstract Objective The objective of this study was to evaluate picture of the major and minor duodenal papillae in patients with autoimmune pancreatitis (AIP). Methods Endoscopic features of the major and minor papillae were examined in 59 and 13 patients with AIP. After steroid therapy, changes of the major and minor papillae were observed in 5 and 6 patients. The major and minor papillae were observed with narrow band imaging in 24 and 6 patients. Biopsy specimens from the major (n = 50) and minor (n = 13) papillae were immunostained using an anti-IgG4 antibody. Results Endoscopic features of the major and minor papillae were abnormal in 26 patients (44%; swelling [n = 20] and redness [n = 14]) and 5 patients (38%; swelling [n = 5]). Swelling of the pancreatic head, irregular narrowing of the main pancreatic duct of the pancreatic head, stenosis of the lower bile duct, and abundant infiltration of IgG4-positive plasma cells were more frequent in the patients with an abnormal major papilla compared with those with a normal major papilla. On narrow band imaging, dilated vessels were observed in abnormal papillae. After therapy, swelling of the major and minor papillae improved in all 4 and 2 patients. Conclusions Endoscopic features of the major and minor papillae were abnormal in 44% and 38% of the patients with AIP. © 2014 by Lippincott Williams & Wilkins.