Diverticulum With Papillae: Does Position of Papilla Affect Technical Success?

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Tract Diseases

Background:

• Peripapillary diverticulum (PPD) is associated with biliary diseases and can complicate endoscopic retrograde cholangiopancreatography (ERCP).
• The anatomical relationship between PPD and the papilla influences ERCP technique and outcomes.

Purpose of the Study:

• To investigate how the localization and position of the papilla relative to a peripapillary diverticulum affect the success of therapeutic ERCP.
• To analyze the impact of PPD on ERCP cannulation, procedure time, success rates, and complications.

Main Methods:

• Prospective study of 1205 patients undergoing ERCP over 16 months.
• Papillary position relative to PPD was categorized using a clock face analogy.
• Evaluated success of biliary cannulation, procedure duration, treatment success, and complication rates.

Main Results:

• 222 patients (18.5%) had PPD; median age 68.9 years, 55.4% female.
• Papilla positions: 7 o'clock (40.5%), 6 o'clock (28.8%), 5 o'clock (28.3%), 1 o'clock (2.3%).
• Cannulation was more difficult for papilla at 1 o'clock (P<0.05); PPD did not increase overall complications or affect therapeutic success.

Conclusions:

• Papillary position relative to PPD can influence cannulation difficulty during ERCP.
• Additional techniques, potentially percutaneous approaches, may be needed for papilla at 1 o'clock.
• PPD itself does not negatively impact overall ERCP therapeutic success or complication rates.