The Effect of Periampullary Diverticulum on Technical Success Rate of Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis

Document Type : Review Article

Authors

1 Professor, Liver and Gasterointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Associate Professor, Liver and Gasterointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Gastroenterology Fellow, Liver and Gasterointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

4 Student of Medicine, Liver and Gasterointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

5 Researcher, Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman AND Clinical Librarian, Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Currently, endoscopic retrograde cholangiopancreatography (ERCP) is one of the most practical measures in the diagnosis and management of various pancreatobiliary diseases. Difficult cannulation which contributes to developing side effects of ERCP, is influenced by many factors, one of which is anatomic variants such as periampullary diverticulum (PAD). The purpose of current systematic review study was the investigation of the effect of periampullary diverticulum on technical success rate of endoscopic cholangiopancreatography. The general conclusion would be presented based on statistical analysis.Methods: In the current study, MEDLINE, PubMed and EMBASE databases were searched in February 30th, 2012 using a sensitive search strategy to retrieve relevant studies in English language. The data met the inclusion criteria were selected for the study. Statistical analysis was carried out using CMA.2 software.Findings: Eleven articles with a total sample size of 12243 and an average consensus of 88% among researchers entered into the survey and all of the necessary data were obtained. The results of statistical analysis indicated low success rate of cannulatoin in patients with PAD in comparison with those without it (OR = 0.502؛ CI 95% (0.262-0.961); P < 0.038).Conclusion: Performing ERCP cannulation in patients with and without PAD carries a lower success rate respectively. Nevertheless, the recent studies which employ new methodology does not demonstrate this low success rate.

Keywords

References

  1. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg 1968; 167(5): 752-6.
  2. Petersen BT. ERCP outcomes: defining the operators, experience, and environments. Gastrointest Endosc 2002; 55(7): 953-8.
  3. Subhani JM, Kibbler C, Dooley JS. Review article: antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). Aliment Pharmacol Ther 1999; 13(2): 103-16.
  4. Enns R, Eloubeidi MA, Mergener K, Jowell PS, Branch MS, Pappas TM, et al. ERCP-related perforations: risk factors and management. Endoscopy 2002; 34(4): 293-8.
  5. Michalodimitrakis M, Christodoulou P, Tsatsakis AM, Askoxilakis I, Stiakakis I, Mouzas I. Death related to midazolam overdose during endoscopic retrograde cholangiopancreatography. Am J Forensic Med Pathol 1999; 20(1): 93-7.
  6. Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 2004; 59(7): 845-64.
  7. Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari AP, Jr., Montes H, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56(5): 652-6.
  8. Grigoriu M, Palade R, Lutic C. Periampullar diverticulum--related to bilio-pancreatic disorders. Chirurgia (Bucur ) 2010; 105(1): 37-43. [In Romanian].
  9. Lobo DN, Balfour TW, Iftikhar SY, Rowlands BJ. Periampullary diverticula and pancreaticobiliary disease. Br J Surg 1999; 86(5): 588-97.
  10. Lotveit T, Skar V, Osnes M. Juxtapapillary duodenal diverticula. Endoscopy 1988; 20(Suppl 1): 175-8.
  11. Kirk AP, Summerfield JA. Incidence and significance of juxtapapillary diverticula at endoscopic retrograde cholangiopancreatography. Digestion 1980; 20(1): 31-5.
  12. Boix J, Lorenzo-Zuniga V, Ananos F, Domenech E, Morillas RM, Gassull MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech 2006; 16(4): 208-11.
  13. Kennedy RH, Thompson MH. Are duodenal diverticula associated with choledocholithiasis? Gut 1988; 29(7): 1003-6.
  14. Wilk PJ, Mollura J, Danese CA. Jaundice and pancreatitis caused by a duodenal diverticulum. Am J Gastroenterol 1973; 60(3): 273-9.
  15. Vaira D, Dowsett JF, Hatfield AR, Cairns SR, Polydorou AA, Cotton PB, et al. Is duodenal diverticulum a risk factor for sphincterotomy? Gut 1989; 30(7): 939-42.
  16. Tham TC, Kelly M. Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Endoscopy 2004; 36(12): 1050-3.
  17. Chang-Chien CS. Do juxtapapillary diverticula of the duodenum interfere with cannulation at endoscopic retrograde cholangiopancreato-graphy? A prospective study. Gastrointest Endosc 1987; 33(4): 298-300.
  18. Egger M, Smith GD, Altman D. Principles of and procedures for systematic reviews. In: Egger M, Smith GD, Altman D, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London, UK: BMJ Publishing Group; 2001. p. 23-42.
  19. Rosolowski M, Baniukiewicz A, Wroblewski E, Kostrzewska M, Dąbrowski A. Juxtapapillary duodenal diverticulum's effect on common bile duct stones formation, course and complications of ERCP. Gastroenterologia Polska 2009; 16(1): 13-5.
  20. Panteris V, Vezakis A, Filippou G, Filippou D, Karamanolis D, Rizos S. Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate. Gastrointest Endosc 2008; 68(5): 903-10.
  21. Chiang TH, Lee YC, Chiu HM, Huang SP, Lin JT, Wang HP. Endoscopic therapeutics for patients with cholangitis caused by the juxtapapillary duodenal diverticulum. Hepatogastroenterology 2006; 53(70): 501-5.
  22. Horaguchi J, Fujita N, Noda Y, Kobayashi G, Kimura K, Ito K, et al. Juxtapapillary diverticula and endoscopic treatment of bile duct stones. Digestive Endoscopy 2005; 17(4): 304-9.
  23. Rajnakova A, Goh PM, Ngoi SS, Lim SG. ERCP in patients with periampullary diverticulum. Hepatogastroenterology 2003; 50(51): 625-8.
  24. Lobo DN, Balfour TW, Iftikhar SY. Periampullary diverticula: consequences of failed ERCP. Ann R Coll Surg Engl 1998; 80(5): 326-31.
  25. Fogel EL, Sherman S, Lehman GA. Increased selective biliary cannulation rates in the setting of periampullary diverticula: main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. Gastrointest Endosc 1998; 47(5): 396-400.
  26. Ajdarkosh H, Sohrabi M, Zamani F. The main complications of ERCP. Govaresh 2012; 17(3): 161-8. [In Persian].
Journal of Isfahan Medical School
Volume 31, Issue 242 - Serial Number 242
May and June 2013
Pages 973-983

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History

  • Receive Date: 30 May 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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