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4 - Is periampullary diverticulum a nightmare in ERCP?
Salih Boğa, Hüseyin Alkım, Ali Rıza Köksal, Pınar Sayın, İlker Sen, Canan Alkım
Objective: Periampullary diverticulum (PAD) is an acquried luminal pathology that is located in the second segment of duodenum and Ampulla of Vater is located in or aside of it. We aimed to determine the frequency of periampullary diverticulum in endoscopic retrograde cholangiopancreatography (ERCP) and the effect of presence of periampullary diverticulum on ERCP success and complications.
Material and Method: The ERCP procedures held in Gastroenterologic Endoscopy Unit of Sisli Hamidiye Etfal Training and Research Hospital between years 2011-2014 were retrospectively evaluated.
Results: Periampullary diverticulum was found in 112 of (11.8%) 948 cases who underwent ERCP with various indications. A 1026 procedures were done to 836 patients without periampullary diverticulum and 136 procedures were done to 112 patients with periampullary diverticulum. No statistically significant difference was found in terms of number of ERCP procedure per patient between patients with and without periampullary diverticulum (1.21 vs. 1.23 p=0.838). Common bile duct cannulation failed in 8 (7%) of patients with periampullary diverticulum whereas this cannulation was unsuccessful in 54 (6.4%) of patients without periampullary diverticulum (p=0.859). The mean age of cases with periampullary diverticulum (72.7±12.2 years) was statistically significantly higher than the ones without periampullary diverticulum (56.8±16.4 years) (p<0.001). The rate of female gender was statistically significantly higher in patients with periampullary diverticulum compared to ones without (72.2% vs. 54.6%, p=0.042). No statistically significant difference was found in terms of ERCP complications such as bleeding, pancreatitis, and perforation between two groups.
Conclusion: Periampullary diverticula are more frequently found in elderly and female patients. Although some of the studies reported increased rates of ERCP complications in patients with periampullary diverticula, no significant difference was found in terms of ERCP complications between patients with and without periampullary diverticulum in this study. These results are important because they demonstrate that patients with periampullary diverticulum can undergo ERCP as safely and efficiently as the patients without periampullary diverticulum when the procedure is done by careful endoscopists in experienced clinics.
Keywords: Endoscopic retrograde cholangiopancreatography, complication, periampullary diverticulum
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