ERCP Features and Outcome in Patients with Periampullary Duodenal Diverticulum

Abstract

Background. Although periampullary diverticulum is usually asymptomatic and discovered incidentally in patients during endoscopic retrograde cholangiopancreatography (ERCP), it may lead to post-ERCP morbidity. We compared baseline characteristics and clinical data as well as ERCP results in patients with and without periampullary diverticulum. Methods. Clinical, laboratory, and ERCP data of 780 patients referred to the Taleghani Hospital, as a great referral endoscopy center, in Iran were prospectively analyzed. Results. The periampullary diverticulum was identified in 44 patients (5.6%). Cannulation of common bile duct was more failed in patients with diverticulum compared to others (35.5% versus 11.5, P < 0.001). Patients with diverticulum had eight times more often common bile duct stone compared to patients without diverticulum (54.5% versus 12.2%, P < 0.001). Post-ERCP complications were observed in 2.3% and 4.2% of patients with and without diverticulum, respectively, which did not significantly differ in both groups. Conclusion. Because of more failure cannulation in the presence of periampullary diverticulum, ERCP requires more skills in these patients. Prevalence of common bile duct stone was notably higher in patients with diverticulum; therefore, more assessment of bile stone and its complications in these patients is persistently recommended.

The Impact of Duodenal Diverticuli and the Execution of Endoscopic Retrograde Cholangiopancreaticography

“…It is reported in the literature that stones in the common bile duct occur significantly more often in patients with diverticuli [12, 13], indicating that the anatomical abnormality and malfunction of the sphincter of Oddi possibly play an important role in the formation of stones [14]. Also periampullary diverticuli are associated with larger stones and severe cholangitis [15, 16].…”

“…According to the literature, this is not the case. ERCP appeared to be a safe procedure also in patients with diverticuli, with a good success rate and low complications [1, 10, 13], although there is one study reporting more post-ERCP pancreatitis [11]. …”

Comparison between double‐guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation

“…Compared to standard cannulation, DWT may replace standard cannulation or become the salvage procedure in cases of unsuccessful biliary cannulation as a result of its high success rate with an acceptable incidence of PEP . For patients with periampullary duodenal diverticulum, DWT may offer a safe and effective method in biliary cannulation compared to TPS …”

Impact of Periampullary Diverticulum on Biliary Cannulation and ERCP Outcomes: A Single-Center Prospective Study

“…Adverse events included post-ERCP pancreatitis, perforations, cholangitis, and post-procedural bleeding evidenced by a drop-in hemoglobin >2g/dl. All adverse events were defined according to published criteria [14].…”

“…The first group of studies published in the 1980s and 1990s suggested a significantly higher rate of cannulation's failure in patients with PAD, prolonged procedure time, and an increase in adverse events' rates [10], [11]. The second group of studies showed that there is no significant difference in the cannulation procedure success in case of presence or absence of PAD [12]- [14]. Moreover, recent prospective studies did not reveal any significant difference in either overall adverse events or a specific event, especially PEP [15]- [17].…”