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Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: a single-center experience

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Abstract

Background

Periampullary diverticulum (PAD) is frequently come upon during endoscopic retrograde cholangiopancreatography (ERCP), especially in elderly patients. However, less is known about the role of PAD in biliary cannulation difficulty.

Aim

This study aims to investigate the association of PAD and difficult cannulation and evaluate the impact of different types of PAD on the cannulation success rate and adverse events.

Methods

Prospectively collected data on a total of 636 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) were divided into two groups based on the presence or absence of PAD. Besides, the patients were classified based on the PAD types into three groups. The primary outcomes were cannulation success rate, cannulation time, and ERCP-related adverse events. Further, the difficult cannulation and presence of PAD were analyzed using logistic regression models.

Results

Significant higher rates of biliary stones, cholangitis, and biliary pancreatitis were observed in the PAD group. Successful selective cannulation was achieved in 97.6% in the PAD group and 95.3% in the control group. The cannulation time was significantly longer in the presence of PAD. There was no significant difference in the rate of overall adverse events and post-ERCP pancreatic PEP. Multivariate analysis showed that type 1 PAD, biliary stones, and cholangitis were factors related to difficult cannulation.

Conclusion

The presence of PAD did not affect the duration or success of the ERCP procedure. However, it was associated with longer cannulation time and an increase in the cannulation difficulty, especially with PAD type 1.

Clinical Trial Study Registration This study is approved by Nanjing Medical University and registered at ClinicalTrial.gov PRS with ID/NCT03771547/.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Institute of Digestive Endoscopy and Medical Centre for Digestive Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu, China

    Fatema Tabak, Guo-Zhong Ji & Lin Miao

Authors
  1. Fatema Tabak
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  2. Guo-Zhong Ji
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  3. Lin Miao
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Contributions

Data curation, FT; Formal analysis, FT; Project administration, G-ZJ and LM; Resources, FT; Supervision, G-ZJ and LM; Writing—original draft, FT; Writing—review & editing, FT, G-ZJ, and LM.

Corresponding author

Correspondence to Lin Miao.

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Fatema Tabak, Guo-Zhong Ji, and Lin Miao have no conflicts of interest or financial ties to disclose.

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Tabak, F., Ji, GZ. & Miao, L. Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: a single-center experience. Surg Endosc 35, 5953–5961 (2021). https://doi.org/10.1007/s00464-020-08080-8

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  • DOI: https://doi.org/10.1007/s00464-020-08080-8

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