Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate

Background: Periampullary diverticula (PAD) are found in 9% to 32% of patients who undergo an ERCP Published studies confer conflicting results regarding the true impact of PAD on the technical success and complications of ERCP. Objective: The aim of the study was to investigate and compare success rate, difficulty at cannulation, and complications between patients with and without PAD, as well as to identify independent factors that influence the difficulty at cannulation. Design: A prospective study. Setting: Tzaneio General Hospital. Patients: A total of 601 consecutive patients who under-went an ERCP were divided into 2 groups according to the presence (group A, 117 patients) or absence (group B, 484 patients) of PAD. Patients with undetectable papilla were excluded from the study cohort. The incidence of undetectable papilla was 8.3% in patients with duodenal diverticula and 0.9% in patients without duodenal diverticula (P = .000). Results: Successful cannulation was achieved in up to 94.9% and 94.8% in groups A and 13, respectively. The effort and difficulty at attempting this goal was different between the groups (43.5% vs 59.1%, P = .003), because patients without PAD were subjected to more vigorous attempts or even the pre-cut technique to attain a cholangiogram. There was no significant difference between the groups in the complication rate either in total or in 9 any particular patient. Multivariate logistic regression analysis showed 3 of the variables, namely choledocholithiasis, abnormal papilla, and the presence of diverticula, remained significant, and all of them presented with odds ratios indicating an easier cannulation attempt. Limitation: A nonrandomized study. Conclusions: The finding of a periampullary diverticulum during an ERCP should not be considered an obstacle to a successful cannulation and, furthermore, may be an indicator of an easier cannulation attempt, provided that the papilla can be found with confidence. Concerns about increased complications are not substantiated in this study. (Gastrointest Endosc 2008;68:903-10.)