Impact of periampullary diverticula on the outcome and fluoroscopy time in endoscopic retrograde cholangiopancreatography

摘要

BACKGROUND: It  is  unclear  whether  the  presence  of periampullary diverticula (PAD) affects technical success and complication  rates  during  endoscopic  retrograde  cholangio-pancreatography  (ERCP).  Moreover,  the  impact  of  PAD  on fluoroscopy duration is still unknown. The present study aimed to  investigate  the  success  rate  and  difficulty  of  common  bile duct  (CBD)  cannulation,  post-procedure  complications  and fluoroscopy duration in patients with and without PAD. METHODS: Patients  from  January  2008  to  December  2010 with  PAD  (group  A)  and  without  PAD  (group  B)  and  similar indications for therapeutic ERCP were prospectively compared. The  comparison  included  patient  characteristics,  findings of  ERCP,  and  details  of  procedure  and  fluoroscopy  time.  The influence of papilla's location with respect to the diverticulum on procedure was also investigated. RESULTS: A  total  of  428  consecutive  patients  who  had undergone  therapeutic  ERCP  for  similar  indications  were divided in two groups according to the presence (group A, 107 patients) or absence (group B, 321 patients) of PAD. The mean age and ASA score of the patients with PAD were significantly higher than those patients without PAD. The main indication was  choledocholithiasis.  Successful  final  CBD  cannulation was achieved in 97.20% of the patients in group A vs 99.69% in group B (P=0.05). CBD diameter, number of stones and the largest  stone  size  were  significantly  higher  in  group  A  than group  B  (P<0.001).  Complete  clearance  of  the  CBD  after  the first attempt was achieved in 85.86% and 94.75% of the patients in groups A and B, respectively (P=0.03). In both groups, the time  needed  to  complete  the  procedure  and  fluoroscopy  time was  significantly  longer  in  patients  with  PAD  (22.87  vs  18.99 minutes,  P<0.001;  76.51  vs  47.42  seconds,  P<0.001).  There was  no  significant  difference  between  the  two  groups  in  the complication rate. The type of papilla's location with respect to the  diverticulum  did  not  influence  the  total  cannulation  rate and post-procedure complications. CONCLUSION: The  presence  of  a  PAD  does  not  affect  the success rate and complications of therapeutic ERCP in expert hands; however, the fluoroscopy time is significantly longer in patients with PAD.