Does periampullary diverticulum affect ERCP cannulation and post-procedure complications? an up-to-date meta-analysis

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary and Pancreatic Diseases

Background:

• Periampullary diverticulum (PAD) is a common finding in the duodenum.
• Its impact on the success and safety of endoscopic retrograde cholangiopancreatography (ERCP) remains debated.
• Understanding this relationship is crucial for optimizing ERCP outcomes.

Purpose of the Study:

• To conduct a meta-analysis evaluating the role of PAD in ERCP.
• To assess the association between PAD and cannulation failure.
• To determine the impact of PAD on early ERCP-related complications.

Main Methods:

• A comprehensive literature search was performed to identify relevant studies.
• Twenty-six studies involving 23,826 patients undergoing ERCP were included.
• Statistical analyses were conducted using Review Manager 5.3, with forest plots displaying confidence intervals.

Main Results:

• PAD was significantly associated with an increased overall cannulation failure rate (RR=1.46, 95% CI: 1.27-1.67).
• However, studies published post-2000 showed no significant association between PAD and cannulation failure (RR=1.16, 95% CI: 0.96-1.41).
• PAD increased the risk of ERCP-related pancreatitis (RR=1.32), perforation (RR=1.73), and bleeding (RR=1.48).

Conclusions:

• PAD increases the overall risk of cannulation failure during ERCP.
• The association between PAD and cannulation failure appears diminished in recent studies.
• PAD is linked to a higher incidence of early ERCP complications, including pancreatitis, perforation, and bleeding.