Introduction
Several factors affect the difficulty of endoscopic retrograde cholangiopancreatography (ERCP) (Facciorusso et al.). This study aimed to evaluate whether the intra- and peri-diverticular location of the papilla has an impact on the results of ERCP for common bile duct stones.
Aims & Methods
Retrospective evaluation of patients without previous sphincterotomy undergoing ERCP for common bile duct stones between August 2020 and February 2023. Data on the patient (age, sex, comorbidities), procedure (elective/urgent, location and type of papilla, techniques used, successful cannulation, diagnosis, immediate complications), and outcomes (complications at 3, 30, and 90 days, need for repeating ERCP) were collected.
Results
Of the 769 patients undergoing ERCP during this period, 224 met the inclusion criteria (median age 76 years, 58% female). The papilla had an intra-diverticular location in 20 and a peri-diverticular location in 45, while it was not dependent on the diverticula in the remaining 159. Regarding the endoscopic classification (SADE; Haraldsson et al.), most were type 1 (55%) or type 2 (20%). The cannulation rate was 93%, with precut being used in 18% (fistulotomy/papillotomy n=22; transpancreatic precut n=14). The cannulation rate was significantly lower in patients with intra-diverticular and peri-diverticular papilla (75% and 87%, respectively, versus 97%; p<0.01), being the precut use also higher (20% and 31%, p=0.038). The ability to completely remove stones in the index ERCP (efficacy) was lower in patients with intra- or peri-diverticular papilla (71% and 70% versus 85%, p=0.04). There were no differences in intraprocedural complications (n=8, p=0.42), at 3 (n=20, p>0.05), 30, and 90 days (n=1). However, the need for repeating ERCP was different between groups (38% peri-diverticular, 25% intra-diverticular, versus 15%; p<0.01).
Conclusion
The intra- or peri-diverticular location of the papilla limits the cannulation rate and efficacy of ERCP, requiring more frequent use of advanced cannulation techniques and repeat procedures. However, it should be noted that no more complications occurred in these locations.
References
Haraldsson, E., et al. Endoscopic classification of the papilla of Vater. Results of an inter-and intraobserver agreement study. United European Gastroenterology Journal 5.4 (2017): 504-510.
Facciorusso A, et al. Comparative efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis. Gastrointest Endosc. 2022;95(1):60-71.
