The Usefulness of Cap-assisted Endoscopic Retrograde Cholangiopancreatography for Cannulation Complicated by a Periampullary Diverticulum

Endoscopic ultrasound (EUS) was originally devised as a novel diagnostic technique to enable endoscopists to stage malignancies and acquire tissue. However, it rapidly advanced toward therapeutic applications and has provided gastroenterologists with the ability to effectively treat and manage advanced diseases in a minimally invasive manner. EUS-guided biliary drainage (EUS-BD) has gained considerable attention as an approach to provide relief in malignant and benign biliary obstruction for patients when endoscopic retrograde cholangiopancreatography (ERCP) fails or is not feasible. Such instances occur in those with surgically altered anatomy, gastroduodenal obstruction, periampullary diverticulum or prior transampullary duodenal stenting. While ERCP remains the gold standard, a multitude of studies are showing that EUS-BD can be used as an alternative modality even in patients who could successfully undergo ERCP. This review will shed light on recent EUS-guided advancements and techniques in malignant and benign biliary obstruction.

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Effect of periampullary diverticulum on technical success and complications of endoscopic retrograde cholangiopancreatography: Single center experience

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.173960 ◽

2015 ◽

Vol 6 (04) ◽

pp. 149-157

Author(s):

Mohammed A. Omar

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Multivariate Logistic Regression Analysis ◽

Duodenal Perforation ◽

Biliary Stones ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Single Center Experience ◽

Periampullary Diverticulum ◽

Group A ◽

Group B

Abstract Context: The incidence of the periampullary duodenal diverticulum (PAD) varies widely from 1 to 32.8%. Although it is usually asymptomatic, its association with various pathological conditions such as choledocholithiasis increased the incidence of complications and cannulation failures after endoscopic retrograde cholangiopancreatography (ERCP) has been well recognized in various studies. Aim: The aim of this study was to investigate and compare the success rate, difficult cannulation, and complications between patients with and without PAD. Settings and Design: A prospective observational study. Subjects and Methods: The study includes 1022 consecutive patients who underwent an ERCP during the period from June 2010 to June 2015. The patients were divided into 2 groups according to the presence (Group A, 114 patients) or absence (Group B, 908 patients) of PAD. Statistical Analysis Used: SPSS version 16. Results: Successful cannulation was achieved in up to 90.4% and 95.9% in Groups A and B, respectively (P = 0.12). The difficulty at attempting this goal was different between the groups (33.3% vs. 16%, P < 0.001). Duodenal perforation and recurrent biliary stones formation were the only significant post-ERCP complications between both groups. Multivariate logistic regression analysis showed 3 significant variables (abnormal papilla, the presence of diverticula, and stricture) with odds ratios indicating a difficult cannulation attempt. Conclusion: The finding of a PAD should not be considered an obstacle to a successful biliary cannulation, but requires more skills. However, it is associated with difficult cannulation, prolonged cannulation and procedure time, decreased the rate of successful stone removal, and increased the incidence of primary and recurrent biliary stones formation.

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Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation

World Journal of Gastrointestinal Endoscopy ◽

10.4253/wjge.v8.i6.282 ◽

2016 ◽

Vol 8 (6) ◽

pp. 282 ◽

Cited By ~ 15

Author(s):

Ahmed Youssef Altonbary ◽

Monir Hussein Bahgat

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Periampullary Diverticulum

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ERCP Features and Outcome in Patients with Periampullary Duodenal Diverticulum

ISRN Gastroenterology ◽

10.1155/2013/217261 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

Amir Houshang Mohammad Alizadeh ◽

Esmaeil Shamsi Afzali ◽

Anahita Shahnazi ◽

Mirhadi Mousavi ◽

Siavash zafar Doagoo ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Common Bile Duct Stone ◽

Clinical Laboratory ◽

Bile Duct Stone ◽

Duodenal Diverticulum ◽

Endoscopic Retrograde ◽

Periampullary Diverticulum ◽

Baseline Characteristics

Background. Although periampullary diverticulum is usually asymptomatic and discovered incidentally in patients during endoscopic retrograde cholangiopancreatography (ERCP), it may lead to post-ERCP morbidity. We compared baseline characteristics and clinical data as well as ERCP results in patients with and without periampullary diverticulum. Methods. Clinical, laboratory, and ERCP data of 780 patients referred to the Taleghani Hospital, as a great referral endoscopy center, in Iran were prospectively analyzed. Results. The periampullary diverticulum was identified in 44 patients (5.6%). Cannulation of common bile duct was more failed in patients with diverticulum compared to others (35.5% versus 11.5, P<0.001). Patients with diverticulum had eight times more often common bile duct stone compared to patients without diverticulum (54.5% versus 12.2%, P<0.001). Post-ERCP complications were observed in 2.3% and 4.2% of patients with and without diverticulum, respectively, which did not significantly differ in both groups. Conclusion. Because of more failure cannulation in the presence of periampullary diverticulum, ERCP requires more skills in these patients. Prevalence of common bile duct stone was notably higher in patients with diverticulum; therefore, more assessment of bile stone and its complications in these patients is persistently recommended.

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