Periampullary duodenal diverticula (PDD). Does it really matter for successful ERCP.

Jan M Krzak, MD1, Jonas S Jensen, MD1, Poul B Thorsen, MD, PhD1, Ada M Krzak2, Lars Stig Jorgensen1. 1Lillebaelt Hospital, Kolding, Denmark, 2University of Cambridge

OBJECTIVES: The aim of this study was to asses how periampullary duodenal diverticula affects successful deep common bile duct cannulation (ERCP) in Danish population.

METHODS: Prospectively recorded data between January 2006 and August 2015, from a single referral ERCP Centre in Denmark, were analyzed. Two groups were identified and compared. Group A with and group B without periampullary duodenal diverticula. Data on age, gender, successful deep common bile duct cannulation, Needle knife pre-cut rate, procedure associated complications and duration of procedure were registered.  For comparisons, Chi-square test, T-tests (continuous variables distributed normally), and Mann-Whitney Ranksum tests, (continuous variables not-normally distributed), were used. Statistical significance level was set to 5%. Statistical software package SPSS ver. 23.0 was used.

RESULTS: A total of 1734 consecutive patients (702 men, and 1032 women) underwent 2834 ERCP procedures. Group A consisted of 172 (9.9%) patients (45% men, 55% women), group B consisted of 1562 (40% men, 60% women) (P=0.23). Mean age in both groups was 63.4 (13-101 years). In group A mean age was statistically significantly higher 72.9 years compared to 62.4 years in group B (P<0.001). 271 procedures were performed in group A (ratio 1.55±0.83 per patient), while 2563 in group B (1.64±1.18) (P=0.33). Successful deep common bile duct cannulation was similar in both groups with 88.6% in group A and 90.9% in group B (P=0.2). Needle knife pre-cut were more frequently used in group B (22.4%), however not statistically significantly different when compared to group A (16.2%) (P=0.74). Procedures associated complications such as bleeding requiring simultaneous endoscopic intervention or perforations were similar in both groups with 9 (3.3%) complications in group A and compared to 67 (2.6%) in group B (P=0.49). Totally, 163 (60.1%) procedures in group A took less than 30 minutes while only 15 (5.5%) that required more than 60 minutes compared to 1491 (55.4%) and 131 (5.1%) in group B, respectively. Detailed results and MR / CT / endoscopy imaging of PPD will be presented.

CONCLUSIONS: Prevalence about 10 % of periampullary duodenal diverticula in our department is similar with other reported series whoever it seems to be clear correlation between age and prevalence and PDD. Periampullary duodenal diverticula had not affected successful cannulation neither time of the procedure in our study. 

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