Endoscopic retrograde cholangiopancreatography (ERCP) in patients with periampullary diverticula

The aim of our study was to compare baseline characteristics and clinical data as well as endoscopic retrograde cholangiopancreatography (ERCP) results in patients with and without periampullary diverticulum (PAD).

A single center retrospective analysis was conducted from June 2016 to June 2017 and the patients that had undergone ERCP were divided into two groups, according to the presence (Group A, 43 patients) or absence (Group B, 55 patients) of PAD.

Mean age of patients with PAD was significantly higher than the ones in the control group (69.95 years vs. 55.35 years, p<0.01), but the two groups had a similar structure regarding the gender. The distribution of the PAD types identified 18.6% type 1 diverticula, 25.6% type 2 diverticula, and 55.8% type 3 diverticula, with a mean dimension of 12.7±4.63 mm. Higher rates of failed (11.6% vs. 0%) or difficult cannulation (25.6% vs. 16.3%) were observed in Group A, but the rate of peri-procedural complications was similar in patients with diverticula compared to the control group concerning bleeding, perforation and pancreatitis, with a greater incidence of infections in the group without diverticula.

Our study confirms that PAD is a pathology occurring more frequently with increasing age and can increase the rate of difficult or failed cannulation, but even in this context, there is no increase in the peri-procedural complications even if in training endoscopists perform the procedure.