Carlos M Zavaleta, MD, Fernando A Quesada, MD. Intergastro
Introduction: A classification for Periampullary Duodenal Diverticulum (PAD) was proposed by Boix et al in three types based on location. These anatomical variants may require more expertise from endoscopist in charge to achieve a successful procedure as it has been reported as a factor associated with difficult biliary cannulation.
Aim: To assess differences in difficult biliary cannulation and therapeutic failure between PAD types during ERCP.
Materials and Methods: A 5 year-period (2013-2017) from a Database of indicated/performed ERCPs was reviewed. Patients reported with findings of PAD on their first ERCP attempt were identified and included. ERCP Procedures had been performed by two endoscopic surgeons with more than 10 years of experience at the moment of the Study period.. Patients with PAD were distributed by the three Boix types . Cannulation difficulty was measured, defined as directed by the ESGE guidelines, and measured with Boix grading of 4 grades. Also therapeutic failure rate was measured . Inferencial Statistical analysis of comparison was done using Chi Square test considering P value≤ 0.05 significant for a difference.
Results: 234 patients were included, 157 Women and 77 men with a female/male ratio of 2.03:1, and a median age of 73 years old. Distribution of subjects by Type of PAD: Type I (Inside diverticulum): 69 (29.49%), Type II (in the margin of the diverticulum): 123 (52.56%), and Type III (< 2 cms near the diverticulum): 42 (17.95%). A difference between difficult cannulation and PAD type was observed, with PAD type I having more frequence on the highest type of difficulty (grade 4) (11.6%), and grade 3 (21.73%) p= 0.000. Therapeutic failure rate was higher for Type I: 26.08%, beign statistically significant P=0.000.
Conclusion: In our Study, PAD Type I has the highest rate of difficult biliary cannulation and therapeutic failure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94657
Program Number: P438
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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