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Association of periampullary diverticulum types with post-ERCP hyperamylasemia: a retrospective observational study
Serdar Akca1, Galip Egemen Atar2, Serkan Ocal2
1Department of Gastroenterology, Antalya Training and Research Hospital, Varlik mah. Kazim Karabekir Cd., Antalya, 07100, Turkey. drserdarakca@hotmail.com.
Background:
This study aimed to assess the prevalence of periampullary diverticulum (PAD) among endoscopic retrograde cholangiopancreatography (ERCP) patients in Southwestern Turkey and investigate the association between the new PAD classification, post-ERCP hyperamylasemia, and post-ERCP pancreatitis (PEP).
Materials And Methods:
We retrospectively reviewed 1,317 ERCP procedures performed between January 1, 2022, and December 31, 2023, at Antalya Training and Research Hospital. The PAD type was determined according to the He-xian Shi classification. Hyperamylasemia was defined as an increase of three times the normal level of amylase at 4 to 6 h, and PEP was defined as hyperamylasemia along with abdominal pain lasting more than 24 h.
Results:
A total of 594 naive patients who underwent ERCP were analyzed. PAD was present in 137 patients (23.1%), and the success rate of choledochal cannulation in the first ERCP procedure was 94.3%. There was no difference in the choledochal cannulation rate between patients with and without PAD (95.6%-93.4%, p = 0.59). Asymptomatic hyperamylasemia was observed in 19.3% of the patients. Post-ERCP hyperamylasemia rates were similar between patients with and without PAD (17.5% and 21.2% respectively, p = 0.31). PEP was observed in 8.0% of the patients. Presence of PAD was not a risk factor for post-ERCP pancreatitis (7.3% compared to 8.8%, p = 0.82). When we checked the results according to the type of PAD, the prevalence of post-ERCP hyperamylasemia was significantly lower in patients with type 2b PAD than in those with type 1 and type 2a patients.
Conclusion:
PAD is a common finding in ERCP patients, with a prevalence of 23.1% in our cohort. The rate of choledochal cannulation, post ERCP hyperamylasemia and PEP did not differ between the patients with and without PAD. However, the type of PAD is important; post-ERCP hyperamylasemia is significantly lower in patients with type 2b than in type 1 and type 2a PAD patients. Different subtypes of PAD may have different associations on ERCP outcomes. Further investigations with refined and standardized PAD classification systems are needed.
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