Endoscopic Retrograde Cholangiopancreatography in Patients with Periampullary Diverticula: Analysis of 3259 Cases

Background: Periampullary duodenal diverticulum (PAD) is associated with increased incidence of biliary pathology presumably due to dysfunction of the sphincter of Oddi and ascending bacterial infection from the duodenum. Aim: to compare ERCP performance characteristics and outcomes in patients with (study group) and without PAD (control group). Materials and Methods: This is retrospective cohort study of all patients that have undergone ERCP in our institution from 1993 to 2013. Specific outcomes evaluated included patient demographics, incidence of biliary pathology and utilisation of ERCP based therapeutic maneuvers. A total of 3259 patients were included (775 with PAD and 2484 without PAD). Results: PAD patients were significantly older (mean age 65 versus 58 years, p <0.001). Common bile duct stones were more common in patients with PAD (48.51%) compare with the PAD free group (36.27%) ; p<0.001. Selective cannulation of the bile duct was highly successful in both groups (98% versus 99%). Therapeutic ERCP was more common among patients with PAD (p <0.001). Endoscopic sphincterotomy (ES) and stone extraction were performed more frequently in the PAD group (p <0.001). A trend towards more frequent use of mechanical lithotripsy was seen in the PAD group but the difference did not reach statistical significance (p= 0.10). Conclusion: Patients with PAD undergoing ERCP are older and have higher incidence of biliary pathology. Selective bile duct cannulation and bile duct stone clearance can be successfully accomplished in the vast majority of patients with PAD but the use of therapeutic maneuvers is required more frequently.