None listed
Conditions
Brief summary
Introduction: Intradiverticular ampulla (IA) is found in 9% to 32% of patients undergoing endoscopic retrograde cholagiopancreatography (ERCP). Contradictory results have been reported in the literature with regard to the true impact of IA on the technical success and complication rate of ERCP. Objective: The aim of this study is to evaluate the success rate, difficult cannulation and complication rate between patients with and without IA, as well as to identify any independent factor that may influence the difficulty in cannulation. Design: A retrospective study. Setting: University Hospital of Palermo. Section of General and Thoracic Surgery. Division of Surgical Endoscopy. Patients: A total of 500 consecutive patients who underwent ERCP were divided into 2 groups according to the presence (group A, 81 patients) or absence (group B, 419 patients) of IA. Results: Successful cannulation was achieved in 100% of group A patients compared to 98% of group B patients (p = ns). There was a significant difference (p < 0.05) in the type of cannulation, that was routinary in group B while required guide-wire or special sphincterotome in group A (p < 0.05). Cholangitis (p < 0.05), microstone, stone recurrence (p < 0.05), normal cholangiogram (p < 0.005) and transient hyperamylasemia (p < 0.005) were more frequently observed among group A patients. There was no significant difference in complication rate between both the groups. Conclusions: IA becomes more frequent with ageing and is a risk factor for biliary stone disease. IA is also associated with post-ERCP transient hyperamylasemia and biliary stone recurrence. The finding of an IA at ERCP should not be considered a predictor for failed cannulation. In fact, it may indicate an easier cannulation attempt in selected cases, provided that the papilla can be found with confidence.
Interventions
Retrospective evaluation of patients with biliary pathology related to intradiverticular ampulla of Vater visualized at endoscopic retrograde cholangiopancreatography (ERCP).
The aim of this study is to evaluate the success rate, difficult cannulation and complication rate between patients with and without intradiverticular ampulla of Vater, as well as to identify any independent factor that may influence the difficulty in cannulation. The duration of observation is 1 year.
All the procedures we
Retrospective evaluation of patients with biliary pathology related to intradiverticular ampulla of Vater visualized at endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study is to evaluate the success rate, difficult cannulation and complication rate between patients with and without intradiverticular ampulla of Vater, as well as to identify any independent factor that may influence the difficulty in cannulation. The duration of observation is 1 year. All the procedures were performed by the same skilled team. All patients received a combination of midazolam and fentanyl, on escalating dosing according to the needs for conscious sedation. Supplemental oxygen was also given trans-nasally during the entire procedure. The patients were only observed at the time of ERCP, the successive follow-up was only clinic and laboratoristic at 1, 6 and 12 months after ERCP.
Sponsors
University of Palermo
Eligibility
Sex/Gender
All
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
500 consecutive patients underwent endoscopic retrograde cholangiopancreatography: in the control group are the patients underwent endoscopic retrograde cholangiopancreatography with normal ampulla of Vater
Exclusion criteria
Previous biliary surgery, previous biliary sphincterotomy
Outcome results
None listed