Impact of Periampullary Diverticulum on the Outcome of Endoscopic Retrograde Cholangiopancreatography

Background & Aim Periampullary diverticula (PAD) are frequently encountered during ERCP. Our aim was to study the impact of PAD on ERCP technical aspects and outcome. Patients & Methods: A Retrospective study included all patients subjected to ERCP at our centre (February 2019 - August 2023). Data of patients with PAD including patient characteristics and procedure details were collected, analysed and compared to data of those without PAD, p < 0.05. Results: PAD was detected in 61/686 patients (9%). Patients with PAD were significantly older than others (mean: 65.3 years ± 11 vs 52.6 ± 17, p < 0.001). Presence of PAD was associated with significant higher number of cannulation attempts (3.5 vs 2.5, p < 0.005) and longer cannulation time (8 minutes vs 5, p < 0.01), and insignificant longer procedure time (mean: 50.4 ± 22 minutes vs 47 ± 24, p₌0.2). In PAD patients, the rates of cannulation success and procedure success were lower compared to others (93.4% vs 94.4%, p₌0.2 and 85% vs 91%, p₌0.1) respectively, and there was no significant predilection for certain cannulation technique. Post-ERCP pain was frequently noticed among PAD patients (4.9% vs 3.4%, p₌0.5). Age was the only significant predictor for presence of PAD, taking the cut-off value of ≥ 61 years; age had 75.4% sensitivity, 60% specificity, 15.5% PPV and 96% NPV for the presence of PAD. Conclusion: Periampullary diverticula could be predicted in elderly patients, and despite it requires significantly higher number of cannulation attempts and longer cannulation time, it has insignificant effect on ERCP success rate and complication rate.