Zippi M, Traversa G, Pica R, De Felici I, Cassieri C, Marzano C, Occhigrossi G, Paoluzi P
Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome.
Clin Ter. 2014;165(4):e291-4. doi: 10.7417/CT.2014.1745.
Periampullary diverticula (PAD) are found in 9-32% of patients who undergo endoscopic retrograde cholangiopancreatography (ERCP). PAD are acquired lesions which are rare in patients <40 years, but increasing with age. Several endoscopic studies have revealed an association between PAD and common bile duct (CBD) stones. The presence of a papilla located in the diverticula is also frequent (6.8-54.9%) and represents a restrictive factor for successful cannulation.
A retrospective analysis has been made of data related to the patients with PAD treated at our GI Unit (small center with low case volume), who underwent ERCP in the period 1st January 2010 to 31st March 2014. For each patient were analyzed data regarding sex, age at diagnosis, indication to ERCP, cannulation rate, endoscopic treatment and complications. PAD were classified in 3 different types according to the position of the major papilla.
A total of 647 ERCPs have been performed of which 77 (16.5%) in pts with PAD (48 F, 29 M, mean age: 78.3 years; range: 48-95). PAD type I (inside the diverticulum) were found in 22 pts (28.6 %), Type II (in the margin of the diverticulum or between two PADs) in 36 pts (46.7 %) of which 12 cases between two PADs, type III (near the diverticulm) in 19 pts (24.7 %). The indication for ERCP were: 72 CBD stones (93.5%), 3 cholangiocarcinoma (3.9%) and 2 pancreatic head cancer (2.6%). In cases of difficult cannulation, precut was performed in 12 pts (15.6%). Deep CBD cannulation and endoscopic sphincterotomy (ES) was achieved in 70 cases (90.9%). The other 7 case of failure were all in patients with CBD stones. Complete clearance of CBD stones was achieved in 57 patients (87.7%) (57/65 ERCP/ES). Stent placement was necessary in 8 cases (12.3%) (8/65 ERCP/ES), due to multiple large stones. The adverse events related to ERCP/ES included 4 intraprocedural bleeding (5.7%) (4/70 ERCP/ES) and 1 mild pancreatitis (1.4%) (1/70 ERCP/ES), all managed conservatively.
Our data show that ERCP is a safe procedure also in patients with PAD, with a good success rate and low complications.
在接受内镜逆行胰胆管造影术（ERCP）的患者中，壶腹周围憩室（PAD）的发生率为9% - 32%。PAD是后天性病变，在40岁以下患者中罕见，但随年龄增长而增多。多项内镜研究显示PAD与胆总管（CBD）结石之间存在关联。位于憩室内的乳头也很常见（6.8% - 54.9%），这是成功插管的一个限制因素。
对2010年1月1日至2014年3月31日期间在我们胃肠病科（病例数少的小中心）接受ERCP治疗的PAD患者的数据进行回顾性分析。分析了每位患者的性别、诊断时年龄、ERCP指征、插管率、内镜治疗及并发症等数据。根据主乳头位置，将PAD分为3种不同类型。
共进行了647例ERCP，其中77例（16.5%）为PAD患者（48例女性，29例男性，平均年龄：78.3岁；范围：48 - 95岁）。22例（28.6%）为I型PAD（在憩室内），36例（46.7%）为II型（在憩室边缘或两个PAD之间），其中12例在两个PAD之间，19例（24.7%）为III型（靠近憩室）。ERCP的指征为：72例CBD结石（93.5%），3例胆管癌（3.9%），2例胰头癌（2.6%）。在插管困难的病例中，12例（15.6%）进行了预切开。70例（90.9%）成功进行了胆总管深部插管和内镜括约肌切开术（ES）。另外7例失败病例均为CBD结石患者。57例患者（87.7%）（57/65例ERCP/ES）实现了CBD结石的完全清除。由于结石多且大，8例（12.3%）（8/65例ERCP/ES）需要放置支架。与ERCP/ES相关的不良事件包括4例术中出血（5.7%）（4/70例ERCP/ES）和1例轻度胰腺炎（1.4%）（1/70例ERCP/ES），均经保守治疗。
我们的数据表明，ERCP对于PAD患者也是一种安全的操作，成功率高且并发症少。
