Introduction. Conflicting results have been reported about the true impact of intradiverticula ampulla (IA) on the technical success and complication rate of endoscopic retrograde cholangiopancreatography (ERCP). Patients. A total of 500 patients who underwent ERCP were divided into two groups according to the presence (group A, 81 patients) or absence (group B, 419 patients) of IA. Success rate, difficulty at cannulation, findings at ERCP, and procedure-related complications were retrospectively reviewed. Results. Successful cannulation was achieved in 100% of group A patients compared to 98% of group B patients (P = ns). There was a significant difference in the type of cannulation that was routinary in group B ( ), while requiring guidewire in group A ( ). Cholangitis ( ), microstones ( ), dilated common bile duct without stones ( ), stone recurrence ( ), and transient postprocedure hyperamylasemia ( ) were more frequently observed in group A. There was no significant difference in complication rate between both groups. Conclusions. The finding of an IA at ERCP should not be considered a predictor for failed cannulation. IA is associated with post-ERCP transient hyperamylasemia and is a risk factor for biliary stone disease and its recurrence. 1. Introduction Intradiverticular ampulla (IA) or periampullary duodenal diverticula (PDD) are found in 9% to 32% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). One of the myths of operative biliary endoscopy is that IA makes deep biliary cannulation difficult or even impossible [1]. The aim of our study is to investigate the impact of PDD on technical success and complications of an ERCP. 2. Materials and Methods A total of 551 consecutive ERCPs were performed from January 2008 to December 2012 at our surgical endoscopy unit. Fifty-one patients were excluded from the study because of prior endoscopic sphincterotomy or placement of stent or undetectable papilla after a thorough examination of the second duodenal portion. None of the excluded patients had PDD. As a result, this study includes 500 patients, who were divided into two groups according to the presence or absence of PDD. There were 218 males and 282 females with a mean age of 59.2 years (range, 18 to 89 years). Indications for ERCP included gallstone pancreatitis, common bile duct (CBD) stones, cholangitis, neoplasms (CBD and pancreas), and pancreas divisum. Data were collected from a prospectively maintained database. All the procedures were performed by the same operator, using Olympus TJF 145 side-view endoscopes.
References
[1]
J. Boix, V. Lorenzo-Zú？iga, F. A？a？os, E. Domènech, R. M. Morillas, and M. A. Gassull, “Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula,” Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, vol. 16, no. 4, pp. 208–211, 2006.
[2]
D. N. Lobo, T. W. Balfour, S. Y. Iftikhar, and B. J. Rowlands, “Periampullary diverticula and pancreaticobiliary disease,” British Journal of Surgery, vol. 86, no. 5, pp. 588–597, 1999.
[3]
V. Panteris, A. Vezakis, G. Filippou, D. Filippou, D. Karamanolis, and S. Rizos, “Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate,” Gastrointestinal Endoscopy, vol. 68, no. 5, pp. 903–910, 2008.
[4]
D. Vaira, J. F. Dowsett, A. R. Hatfield et al., “Is duodenal diverticulum a risk factor for sphincterotomy?” Gut, vol. 30, no. 7, pp. 939–942, 1989.
[5]
D. N. Lobo, T. W. Balfour, and S. Y. Iftikhar, “Periampullary diverticula: consequences of failed ERCP,” Annals of the Royal College of Surgeons of England, vol. 80, no. 5, pp. 326–331, 1998.
[6]
T. Zoepf, D.-S. Zoepf, J. C. Arnold, C. Benz, and J. F. Riemann, “The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients,” Gastrointestinal Endoscopy, vol. 54, no. 1, pp. 56–61, 2001.
[7]
A. Rajnakova, P. M. Y. Goh, S. S. Ngoi, and S. G. Lim, “ERCP in patients with periampullary diverticulum,” Hepato-Gastroenterology, vol. 50, no. 51, pp. 625–628, 2003.
[8]
C.-S. Chang-Chien, “Do juxtapapillary diverticula of the duodenum interfere with cannulation at endoscopic retrograde cholangiopancreatography? A prospective study,” Gastrointestinal Endoscopy, vol. 33, no. 4, pp. 298–300, 1987.
[9]
T. C. K. Tham and M. Kelly, “Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography,” Endoscopy, vol. 36, no. 12, pp. 1050–1053, 2004.
[10]
P. Tyagi, P. Sharma, B. C. Sharma, and A. S. Puri, “Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography,” Surgical Endoscopy and Other Interventional Techniques, vol. 23, no. 6, pp. 1342–1345, 2009.
[11]
B. K. Abu Dayyeh and T. H. Baron, “Endoscopic sphincterotomy: indications, techniques and adverse events,” Techniques in Gastrointestinal Endoscopy, vol. 14, no. 3, pp. 141–147, 2010.
[12]
T. L？tveit, M. Osnes, and S. Larsen, “Recurrent biliary calculi: duodenal diverticula as a predisposing factor,” Annals of Surgery, vol. 196, no. 1, pp. 30–32, 1982.
[13]
R. H. Kennedy and M. H. Thompson, “Are duodenal diverticula associated with choledocholithiasis?” Gut, vol. 29, no. 7, pp. 1003–1006, 1988.
[14]
R. I. Hall, C. J. H. Ingoldby, and M. E. Denyer, “Periampullary diverticula predispose to primary rather than secondary stones in the common bile duct,” Endoscopy, vol. 22, no. 3, pp. 127–128, 1990.
[15]
T. L？tveit, M. Osnes, and S. Aune, “Bacteriological studies of common duct bile in patients with gallstone disease and juxta-papillary duodenal diverticula,” Scandinavian Journal of Gastroenterology, vol. 13, no. 1, pp. 93–95, 1978.
[16]
N. Egawa, H. Anjiki, K. Takuma, and T. Kamisawa, “Juxtapapillary duodenal diverticula and pancreatobiliary disease,” Digestive Surgery, vol. 27, no. 2, pp. 105–109, 2010.
