The impact of periampullary diverticula on the endoscopic treatment of choledocholithiasis

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“…Most previous researches confirmed the relation between the high prevalence of PAD and the advanced age, [5,7,10,13,16,[24][25][26][27][28] and this relationship was also reconfirmed in our study since the mean age of patients was significantly higher in patients with PAD than others (52 vs. 41.4 years, P < 0.001). In our study, the incidence of PAD was slightly higher in females (51.8% vs. 48.2%) but not significant (P = 0.86), and this was comparable with most previous studies.…”

“…In our study, the incidence of PAD was slightly higher in females (51.8% vs. 48.2%) but not significant (P = 0.86), and this was comparable with most previous studies. [5,7,13,16,25,27,28] Our results were comparable with the previous results regarding no significant difference in the medical history [13] and indication [5,13,16] for ERCP in patients with or without PAD. On contrary, another study showed that obstructive jaundice was significantly more prevalent in patients without PAD.…”

“…[25] Prevalence rates from 4 to 9% to 25-32.8% have been reported at esophagogastroduodenoscopy, the average being from 10 to 20%. [5,7,10,11,13,16,[23][24][25][26][27] Our study showed the comparable result (11.2%) with the average prevalence in the previous studies.…”

“…[13,[30][31][32][33] These conflicting results might be partly due to differences in study design, patients, operator's experience and the use of new duodenoscopes, special accessories, techniques that facilitate CBD cannulation even in patients with a intradiverticular papilla or a floppy papilla on the edge of a diverticulum and definition of treatment success (e.g., if failure to cannulate during the initial ERCP session was considered treatment failure or if alternative cannulation attempts such as the precut technique were not used). [16,27] On contrary, other studies showed that the presence of diverticula may result in dysfunction of the sphincter of Oddi, which would reduce resistance against the sphincterotome, thereby enhancing cannulation success. [5,7,34] It has been found by biliary manometry that the muscular tone and contractions of the sphincter are decreased in patients with PAD, and this has been attributed to the sustained mechanical compression of the lower CBD by a distended periampullary diverticulum, either as a result of food impaction or increased intraduodenal pressure.…”

“…[5,7,8,10] Our study showed that successful cannulation rate was insignificant between both groups, although it was higher in patients without PAD (90.4% vs. 95.9%, P = 0.12), and this was consistent with many studies. [5,7,8,10,16,27,28] On contrary, many studies showed that successful cannulation in patients with PAD was found to be significantly lower compared with patients without PAD. [13,[30][31][32][33] These conflicting results might be partly due to differences in study design, patients, operator's experience and the use of new duodenoscopes, special accessories, techniques that facilitate CBD cannulation even in patients with a intradiverticular papilla or a floppy papilla on the edge of a diverticulum and definition of treatment success (e.g., if failure to cannulate during the initial ERCP session was considered treatment failure or if alternative cannulation attempts such as the precut technique were not used).…”