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Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis

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Is duodenal diverticulum a risk factor for sphincterotomy?

D Vaira¹, J F Dowsett, A R Hatfield

¹Department of Gastroenterology, Middlesex Hospital, London.

|July 1, 1989

Summary

Endoscopic retrograde cholangiopancreatography (ERCP) is slightly more challenging with duodenal diverticula. However, endoscopic sphincterotomy success and safety remain comparable for patients with or without diverticula.

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Area of Science:

Gastroenterology
Endoscopic procedures
Digestive system anatomy

Background:

Periampullary diverticula are common findings during ERCP.
The impact of duodenal diverticula on ERCP outcomes is not well-established.

Purpose of the Study:

To compare the difficulty and success rates of ERCP and endoscopic sphincterotomy in patients with and without periampullary diverticula.
To assess the safety and efficacy of sphincterotomy in patients with diverticula.

Main Methods:

Retrospective review of 2458 prospectively reported ERCPs.
Comparison of outcomes between patients with periampullary diverticula (n=308) and those without (n=2150).
Analysis of diagnostic cholangiography success, sphincterotomy success, morbidity, and mortality.

Main Results:

Diagnostic cholangiography success was slightly lower in the diverticula group (94.2% vs 96.7%).
Overall endoscopic sphincterotomy success was comparable (95.2% vs 98.0%), with similar morbidity and mortality rates.
Stone clearance in choledocholithiasis was equally successful in both groups.
Medium-term complications were low and similar between groups (1.4% vs 0.7%).

Conclusions:

Diagnostic cholangiography is more challenging with periampullary diverticula.
Endoscopic sphincterotomy can be performed as successfully and safely in patients with or without diverticula, provided successful cholangiography is achieved.