Clin Endosc.  2019 Jan;52(1):65-71. 10.5946/ce.2018.070.

Impact of Periampullary Diverticulum on ERCP Performance: A Matched Case-Control Study

• Corral JE
• Mousa OY
• Kröner PT
• Gomez V
• Lukens FJ

• KMID: 2438147
• DOI: http://doi.org/10.5946/ce.2018.070

Abstract

BACKGROUND/AIMS
Periampullary diverticulum (PAD) is frequently encountered during endoscopic retrograde cholangiopancreatography (ERCP) and has been associated with stone formation in the bile duct. The effects of PAD on the ERCP procedure have been often debated. We aimed to compare the therapeutic success of ERCP between patients with PAD and matched controls.
METHODS
We reviewed all ERCPs with findings of PAD in a national database (n=1,089) and compared them with age- and gendermatched controls in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeutic success rates were compared between groups. Secondary analysis compared PAD cases and controls who had gallstone disease.
RESULTS
The average cohort age was 68.4±14.3 years and 55.1% were male. ERCP success was similar in both groups, and no significant inter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy or visualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients with PAD and controls.
CONCLUSIONS
PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach to cannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.

Keyword

Cholangiopancreatography, endoscopic retrograde; Periampullary diverticulum; Duodenal diverticulum

MeSH Terms

Bile Ducts
Case-Control Studies*
Cholangiopancreatography, Endoscopic Retrograde*
Cohort Studies
Demography
Diverticulum*
Gallstones
Humans
Male
Multivariate Analysis

Figure

• 

  Fig. 1. Study flow diagram. ERCP, endoscopic retrograde cholangiopancreatography; CORI, Clinical Outcomes Research Initiative; PAD, periampullary diverticulum.

• 

  Fig. 2. Procedure time and fluoroscopy time in periampullary diverticulum patients and controls.

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