Impact of Periampullary Diverticulum on ERCP Performance: A matched Case-Control Study
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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 oftendebated. 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 gendermatchedcontrols in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeuticsuccess 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 significantinter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy orvisualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients withPAD and controls. Conclusions: PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach tocannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.
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 oftendebated. 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 gendermatchedcontrols in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeuticsuccess 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 significantinter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy orvisualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients withPAD and controls. Conclusions: PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach tocannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.
참고문헌 (12)
- Christoforidis E, "The role of juxtapapillary duodenal diverticula in biliary stone disease", Gastrointest Endosc, 55, pp.543~547 (2002)
- Chen L, "Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography", Eur J Gastroenterol Hepatol, 29, pp.105~111 (2017)
- Mohammad Alizadeh AH, "ERCP features and outcome in patients with periampullary duodenal diverticulum", ISRN Gastroenterol, 2013, pp.217261~ (2013)
- Vaira D, "Is duodenal diverticulum a risk factor for sphincterotomy", Gut, 30, pp.939~942 (1989)
- Panteris V, "Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate", Gastrointest Endosc, 68, pp.903~910 (2008)
- Tham TC, "Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography", Endoscopy, 36, pp.1050~1053 (2004)
- Boix J, "Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography : a proposed classification of periampullary duodenal diverticula", Surg Laparosc Endosc Percutan Tech, 16, pp.208~211 (2006)
- Cotton PB, "Endoscopic management of bile duct stones;(apples and oranges)", Gut, 25, pp.587~597 (1984)
- Lintott DJ, "Pseudostone at ERCP due to juxtapapillary diverticulum", Clin Radiol, 32, pp.173~176 (1981)
- Katsinelos P, "Impact of periampullary diverticula on the outcome and fluoroscopy time in endoscopic retrograde cholangiopancreatography", Hepatobiliary Pancreat Dis Int, 12, pp.408~414 (2013)
- "Clinical Outcomes Research Initiative (CORI)" (2018)[URL]
- Ramsey PJ, "Appropriate use or overutilization of the CORI database?", Am J Gastroenterol, 104, pp.785~786 (2009)