Periampullary diverticulum: an indicator of easy or difficult cannulation?

Gastrointestinal endoscopy (Impact Factor: 5.37). 11/2009; 70(5):1049; author reply 1049-50. DOI: 10.1016/j.gie.2009.03.016
Source: PubMed
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    ABSTRACT: Periampullary diverticula (PAD) are found in 9% to 32% of patients who undergo an ERCP. Published studies confer conflicting results regarding the true impact of PAD on the technical success and complications of ERCP. The aim of the study was to investigate and compare success rate, difficulty at cannulation, and complications between patients with and without PAD, as well as to identify independent factors that influence the difficulty at cannulation. A prospective study. Tzaneio General Hospital. A total of 601 consecutive patients who underwent an ERCP were divided into 2 groups according to the presence (group A, 117 patients) or absence (group B, 484 patients) of PAD. Patients with undetectable papilla were excluded from the study cohort. The incidence of undetectable papilla was 8.3% in patients with duodenal diverticula and 0.9% in patients without duodenal diverticula (P = .000). Successful cannulation was achieved in up to 94.9% and 94.8% in groups A and B, respectively. The effort and difficulty at attempting this goal was different between the groups (43.5% vs 59.1%, P = .003), because patients without PAD were subjected to more vigorous attempts or even the pre-cut technique to attain a cholangiogram. There was no significant difference between the groups in the complication rate either in total or in any particular patient. Multivariate logistic regression analysis showed 3 of the variables, namely choledocholithiasis, abnormal papilla, and the presence of diverticula, remained significant, and all of them presented with odds ratios indicating an easier cannulation attempt. A nonrandomized study. The finding of a periampullary diverticulum during an ERCP should not be considered an obstacle to a successful cannulation and, furthermore, may be an indicator of an easier cannulation attempt, provided that the papilla can be found with confidence. Concerns about increased complications are not substantiated in this study.
    Gastrointestinal endoscopy 11/2008; 68(5):903-10. DOI:10.1016/j.gie.2008.03.1092 · 5.37 Impact Factor
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    ABSTRACT: Data concerning the association of juxtapapillary duodenal diverticula (JPDD) with biliopancreatic disorders are inconsistent, but an association between bile duct stones and JPDD is widely accepted. The aim of this study was to investigate the frequency of JPDD and its association with biliopancreatic disorders in patients undergoing ERCP. A retrospective analysis was conducted of 5497 consecutive ERCP procedures performed in 2925 patients. Matched-pair analysis yielded 350 pairs of patients with and without JPDD, matched for definite risk criteria such as age, gender, and indication for ERCP. The incidence of JPDD was 12%. Patients with JPDD were significantly older than patients without JPDD (71 vs. 62 years; p < 0.0019) and had a significantly higher bleeding rate after endoscopic sphincterotomy (8.8% vs. 4.8%; p = 0.039). The presence of JPDD correlated with gallbladder stones (29.4% vs. 20.8%; p = 0.039), bile duct stones (46% vs. 33.1%; p < 0.001), and recurrence of bile duct stones (6.6% vs. 1.4%; p = 0.002). There were no significant differences in frequency of acute and chronic pancreatitis as well as pancreas divisum. After multivariate logistic regression analysis, technically difficult ERCP, bleeding after endoscopic sphincterotomy, and bile duct stones remained as independent risk factors. JPDD appears to be a risk factor for complications of endoscopic sphincterotomy and for gallbladder stones, bile duct stones, and their recurrence.
    Gastrointestinal Endoscopy 07/2001; 54(1):56-61. DOI:10.1067/mge.2001.115334 · 5.37 Impact Factor
  • Endoscopy 11/2008; 40(10):875-6; author reply 877. DOI:10.1055/s-2008-1077597 · 5.05 Impact Factor