Is duodenal diverticulum a risk factor for sphincterotomy?

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.