Complications increase in which type of duodenal diverticulum? A retrospective cohort study

Authors

Keywords:

Endoscopic retrograde cholangiopancreatography, duodenum, diverticulum, pancreatitis

Abstract

Aim: In endoscopic retrograde cholangiopancreatography (ERCP), a diverticulum increases complications such as perforation and pancreatitis. We must know which type of diverticulum increases the complications to develop a strategy. The aim of this study is to examine the safety of the ERCP procedure in terms of diverticulum types. Methods: A total of 864 patients aged 65 years and over who underwent ERCP from January 2010 to November 2019 were identified and analyzed in this retrospective cohort study. Demographic findings, indications, successful cannulation rates and complications were compared between groups with and without duodenal diverticula. Results: Of the patients who underwent ERCP, 56.4% were female. The mean age of all patients was 77.39 (65-90) years. The most common indications were common bile duct stones (92.1%). Other indications included cholangitis (1.4%), sphincter Oddi dysfunction (1.6%), pancreatitis (2.1%), Mirizzi syndrome (2.7%), postoperative gallbladder fistula (0.7%), periampullary tumor formation (0.57%) and biliary stenosis (0.23%). Among all patients, 848 (98.1%) had no complications, 2 (0.34%) developed pancreatitis, 1 (0.17%) developed cholangitis and bleeding occurred in 1 (0.17%) patient in the group without a duodenal diverticulum. Among patients with a type I diverticulum, 4 (12.9%) had pancreatitis and 3 (9.6%) had bleeding. One patient (1.16%) had pancreatitis, 1 (1.16%) had cholangitis and 2 (2.33%) had bleeding among the type II group, while in the type III group, 1 (0.64%) had pancreatitis and 1(0.64%) had a perforation. Mortality was seen in 2 (0.23%) patients. A total of 5 (0.57%) periampullary tumors were detected in the study. Conclusion: Our study revealed that patients with a duodenal diverticulum experience more complications than the normal population. Among them, the rate is insignificantly increased in those with a type I duodenal diverticulum. Further studies are needed on this subject.

Downloads

Download data is not yet available.

References

Major P, Dembiński M, Winiarski M, Pędziwiatr M, Rubinkiewicz M, Stanek M, et al. A Periampullary Duodenal Diverticula in Patient with Choledocholithiasis-Single Endoscopic Center Experience. Pol Przegl Chir. 2016;88(6):328-33.

Boix J, Lorenzo-Zuniga V, Ananos F, Domenech E, Morillas RM, Gassuli MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutaneous Tech. 2006;16:208-11.

Corral JE, Mousa OY, Kröner PT, Gomez V, Lukens FJ. Impact of Periampullary Diverticulum on ERCP Performance: A Matched Case-Control Study. Clin Endosc. 2019;52(1):65-71.

Panteris V, Vezakis A, Filippou G, Karamanolis D, Rizos S, et al. Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate. Gastrointest Endosc. 2008;68:903-10.

Akcakaya A, Ozkan OV, Bas G, Karakelleoglu A, Kocaman O, Okan I, et al. Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones. Hepatobiliary Pancreat Dis Int. 2009;8(5):524-8.

Niu F, Liu YD, Chen RX, Niu YJ. Safety and efficacy of enhanced recovery after surgery in elderly patients after therapeutic endoscopic retrograde cholangiopancreatography. Wideochir Inne Tech Maloinwazyjne. 2019;14(3):394–400.

Kouklakis G, Gatopoulou A, Lirantzopoulos N, Efraimidou E, Manolas K. Evaluation of guide wire cannulation technique in elderly patients with choledocholithiasis. J Gastrointestin Liver Dis. 2009;18(2):185-8.

Tham T, Kelly M: Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Endoscopy. 2004;36:1050-53.

Zoepf TD, Zoepf S, Arnold JC, Benz C, Riemann JF. The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients. Gastrointestinal Endoscopy. 2001;54(1):56–61.

Jayaraj M, Mohan BP, Dhindsa BS, Mashiana HS, Radhakrishnan G, Dhir V, et al. Periampullary Diverticula and ERCP Outcomes: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2019;64:1364-76. doi: 10.1007/s10620-018-5314-y.

Chen Q, Jin P, Ji X, Du H, Lu J. Management of difficult or failed biliary access in initial ERCP: A review of current literature. Clin Res Hepatol Gastroenterol. 2019;43(4):365-72.

Manes G, Paspatis G, Aabakken L, Anderloni A, Arvanitakis M, Ah-Soune P, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019;51(5):472-91.

Colan-Hernandez J, Aldana A, Concepcion M, Chavez K, Gomez C, Mendez-Bocanegra A, et al. Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers. Surg Endosc. 2017;31:3711.

Tanisaka Y, Ryozawa S, Mizuide M, Harada M, Fujita A, Ogawa T, et al. Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope for patients with surgically altered gastrointestinal anatomy. Dig Endosc. 2019;31(6):682-9.

Chen YI, Callichurn K, Chatterjee A, Desilets E, Fergal D, Forbes N, et al. ELEMENT TRIAL: study protocol for a randomized controlled trial on endoscopic ultrasound-guided biliary drainage of first intent with a lumen-apposing metal stent vs. endoscopic retrograde cholangio-pancreatography in the management of malignant distal biliary obstruction. Trials. 2019;20(1):696.

Ketwaroo G, Qureshi W. ERCP Success Rate and Periampullary Diverticula: The Pocket Makes No Difference. Dig Dis Sci. 2019;64(5):1072-3.

Mohammad Alizadeh AH, Afzali ES, Shahnazi A, Mousavi M, Mirsattari D, et al. ERCP features and outcome in patients with periampullary duodenal diverticulum. ISRN Gastroenterol. 2013;2013:217261 doi: 10.1155/2013/217261.

Testoni PA, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48:657-83.

Khan BA, Khan SH, Sharma A. Lemmel's Syndrome: A Rare Cause of Obstructive Jaundice Secondary to Periampullary Diverticulum. Eur J Case Rep Intern Med. 2017;4(6):000632.eCollection 2017.

Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, et al. Complications of diagnostic and therapeutic ERCP: A prospective multicenter study. Am J Gastroenterol. 2001;96(2):417-23.

Uomo G, Manes G, Ragozzino A, Cavallera A, Rabitti PG. Periampullary extraluminal Duodenal diverticula and acute pancreatitis: an under estimated etiological association. The American Journal of Gastroenterology. 1996;91(6):1186-8.

Sun Z, Bo W, Jiang P, Sun Q. Different Types of Periampullary Duodenal Diverticula Are Associated with Occurrence and Recurrence of Bile Duct Stones: A Case-Control Study from a Chinese Center. Gastroenterol Res Pract. 2016;6:1-8.

Fatima J, Baron TH, Topazian MD, Houghton SG, Iqbal CW, Ott BJ, et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. Arch Surg. 2007;142(5):448-54; discussion 454-5.

Fritz E, Kirchgatterer A, Hubner D, Aschl G, Hinterreiter M, Stadler B, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc. 2006;64(6):899-905.

Osnes M, Rosseland AR, Aabakken L. Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection. Gut. 1986;27(10):1193-8.

Chong VH, Yim HB, Lim CC. Endoscopic retrograde cholangiopancreatography in the elderly: outcomes, safety and complications. Singapore Med J. 2005;46(11):621-6.

Choi CS, Choi SC, Seo GS, Cho EY, Cho HJ, Kim YS, et al. Association between diverticulosis and colonic neoplasm in Koreans. The Korean Journal of Gastroenterology. 2007;49(6):364-8.

Agarwal N, Sharma BC, Sarin SK. Endoscopic management of acute cholangitis in elderly patients. World J Gastroenterol. 2006;12(40):6551-5.

Downloads

Published

2020-11-01

Issue

Section

Research Article

How to Cite

1.
Akaydın M, Akay T, Leblebici M. Complications increase in which type of duodenal diverticulum? A retrospective cohort study. J Surg Med [Internet]. 2020 Nov. 1 [cited 2023 Jan. 29];4(11):938-42. Available from: https://jsurgmed.com/article/view/813042