Introduction Periampullary duodenal diverticulum (PAD) was first described by J. Chomel in 1710.1 The pathophysiological mechanism of occurrence may include both traction and pulsion. Incidence widely varies between 7%–32% of the patients at the time of endoscopic retrograde cholangiopancreatography (ERCP).2 There is conflicting data on cannulation rates and Post ERCP complications in patients with PAD.
Methods We conducted a retrospective review on the data of all patients who underwent a sphincterotomy in the presence of Periampullary diverticulum between Jan 2007 and Aug 2015. Comprehensive information was gathered with regards to patient’s demographics, procedural indications and procedure success rates. We assessed the cannulation rates, complications and number of procedures required to clear stones during the first ERCP.
Results 389 patients with periampullary diverticulum who underwent sphincterotomy were identified and analysed during this period. The incidence of PAD was 13.2%. 54% were females and the mean age was 74 years (range, 35–100 years). 257 patients (66%) were above the age of 65. The most common underlying diagnoses were Common bile duct (CBD) stones (74%) and Cholangiocarcinoma (12%) followed by Chronic Pancreatitis (6%), Bile leak (2%) and Pancreatic cancer (2%). Other indications were Sphincter of oddi dysfunction, Primary sclerosing cholangitis and IgG4 related cholnagiopathy (4%). Successful cannulation was achieved in 359 patients (92%). 60 patients (15%) needed at least two procedures for successful stone clearance. Successful stone clearance was achieved in 227 patients (79%) of patients with CBD stones. 16 patients (5%) with CBD stones needed more than two ERCP procedures to achieve stone clearance. Combined endoscopic (rendezvous) and percutaneous approach was needed in 12 patients (3%). 11 patients developed post ERCP Pancreatitis (3%). 3 patients (0.84%) had retroperitoneal perforation post sphincterotomy. 8 patients (2%) had moderate to severe post sphincterotomy bleeding requiring transfusion or endoscopic/angiographic intervention. There were no reported cases of procedure related mortality.
Conclusion Endoscopic sphincterotomy is safe in this cohort given the right indication. An other safe adjunct is balloon sphincteroplasty. We did not see any significant increase in Post ERCP mortality or morbidity comparing with national standards. The finding of PAD had no effect on successful cannulation.
References 1 Chomel JB. The Royal Academy of History, Paris. Paris: The Institute France, Academy of Sciences; 1710. p. 37.
2 Tyagi P, Sharma P, Sharma BC, Puri AS. Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc 2009;23:1342–5.
Disclosure of Interest None Declared