Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
Hepatobiliary Pancreat Dis Int. 2013 Aug;12(4):408-14. doi: 10.1016/s1499-3872(13)60063-6.
It is unclear whether the presence of periampullary diverticula (PAD) affects technical success and complication rates during endoscopic retrograde cholangiopancreatography (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.
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.
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.
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.
目前尚不清楚是否存在壶腹周围憩室（PAD）会影响内镜逆行胰胆管造影（ERCP）期间的技术成功率和并发症发生率。此外，PAD 对透视时间的影响仍不清楚。本研究旨在探讨有和无 PAD 的患者在胆总管（CBD）插管成功率、术后并发症和透视时间方面的差异。
2008 年 1 月至 2010 年 12 月，前瞻性比较了有 PAD（A 组）和无 PAD（B 组）且有类似治疗性 ERCP 适应证的患者。比较包括患者特征、ERCP 结果以及手术过程和透视时间的详细信息。还研究了乳头位置相对于憩室对手术的影响。
根据是否存在（A 组，107 例）或不存在（B 组，321 例）PAD 将 428 例接受类似适应证治疗性 ERCP 的连续患者分为两组。A 组患者的平均年龄和 ASA 评分明显高于 B 组。主要适应证为胆总管结石。A 组患者最终 CBD 插管成功率为 97.20%，B 组为 99.69%（P=0.05）。A 组 CBD 直径、结石数量和最大结石大小明显大于 B 组（P<0.001）。A 组和 B 组患者首次尝试后完全清除 CBD 的比例分别为 85.86%和 94.75%（P=0.03）。在两组中，有 PAD 的患者完成手术和透视所需的时间明显较长（22.87 分钟对 18.99 分钟，P<0.001；76.51 秒对 47.42 秒，P<0.001）。两组之间并发症发生率无显著差异。憩室相对于乳头位置的类型并不影响总插管率和术后并发症。
在有经验的医生手中，存在 PAD 并不影响治疗性 ERCP 的成功率和并发症；然而，有 PAD 的患者透视时间明显较长。
