Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2022; 14(2): 132-142
Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.132
Choledocholithiasis characteristics with periampullary diverticulum and endoscopic retrograde cholangiopancreatography procedures: Comparison between two centers from Lanzhou and Kyoto
Ke-Xiang Zhu, Ping Yue, Hai-Ping Wang, Wen-Bo Meng, Jian-Kang Liu, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Azumi Suzuki, Kiyohito Tanaka, Xun Li
Ke-Xiang Zhu, Ping Yue, Wen-Bo Meng, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Xun Li, Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Ke-Xiang Zhu, Ping Yue, Hai-Ping Wang, Wen-Bo Meng, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Xun Li, Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Jian-Kang Liu, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02451, United States
Azumi Suzuki, Kiyohito Tanaka, Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 602-8026, Japan
Author contributions: Zhu KX, Yue P, Suzuki A, Tanaka K and Li X designed the research protocol; Zhu KX, Yue P, Meng WB, Zhang L, Zhu XL, Zhang H, Miao L, Wang ZF, Zhou WC and Li X were responsible for patient enrollment and data acquisition of The First Hospital of Lanzhou University; Suzuki A and Tanaka K were responsible for patient enrollment and data acquisition of Kyoto Second Red Cross Hospital; Li X, Tanaka K and Wang HP contributed to data interpretation; Wang HP and Liu JK contributed to statistical analysis; Zhu KX and Yue P wrote and revised the manuscript; Li X and Tanaka K contributed to final approval of the article; Zhu KX and Suzuki A made equal contributions. Li X and Tanaka K equally contributed to this paper.
Institutional review board statement: The study was reviewed and approved by the First Hospital of Lanzhou University Institutional Review Board (Approval No. LDYYLL 2021-192).
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xun Li, PhD, Chief Doctor, Department of General Surgery, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou 730000, Gansu Province, China. lxdr21@126.com
Received: April 20, 2021
Peer-review started: April 20, 2021
First decision: June 13, 2021
Revised: June 24, 2021
Accepted: January 27, 2022
Article in press: January 27, 2022
Published online: February 27, 2022
Abstract
BACKGROUND

Most of study regarding periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) therapy for choledocholithiasis based on data from one endoscopy center and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical patients.

AIM

To compare the choledocholithiasis clinical characteristics between two regional endoscopy centers and analyze impacts of clinical characteristics on ERCP methods for choledocholithiasis patients with PAD.

METHODS

Patients seen in two endoscopy centers (The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China, and Kyoto Second Red Cross Hospital, Kyoto, Japan) underwent ERCP treatment for the first time between January 2012 and December 2017. The characteristics of choledocholithiasis with PAD were compared between the two centers, and their ERCP procedures and therapeutic outcomes were analyzed.

RESULTS

A total of 829 out of 3608 patients in the Lanzhou center and 241 out of 1198 in the Kyoto center had choledocholithiasis with PAD. Lots of clinical characteristics were significantly different between the two centers. The common bile duct (CBD) diameter was wider, choledocholithiasis size was lager and multiple CBD stones were more in the Lanzhou center patients than those in the Kyoto center patients (14.8 ± 5.2 mm vs 11.6 ± 4.2 mm, 12.2 ± 6.5 mm vs 8.2 ± 5.3 mm, 45.3% vs 20.3%, P < 0.001 for all). In addition, concomitant diseases, such as acute cholangitis, gallbladder stones, obstructive jaundice, cholecystectomy, and acute pancreatitis, were significantly different between the two centers (P = 0.03 to < 0.001). In the Lanzhou center, CBD diameter and choledocholithiasis size were lower, and multiple CBD stones and acute cholangitis were less in non-PAD patients than those in PAD patients (13.4 ± 5.1 mm vs 14.8 ± 5.2 mm, 10.3 ± 5.4 mm vs 12.2 ± 6.5, 39% vs 45.3%, 13.9% vs 18.5%, P = 0.002 to < 0.001). But all these characteristics were not significantly different in the Kyoto center. The proportions of endoscopic sphincterotomy (EST), endoscopic balloon dilatation (EPBD), and EST+EPBD were 50.5%, 1.7%, and 42.5% in the Lanzhou center and 90.0%, 0.0%, and 0.4% in the Kyoto center, respectively. However, the overall post-ERCP complication rate was not significantly different between the two centers (8.9% in the Lanzhou and 5.8% in the Kyoto. P = 0.12). In the Lanzhou center, the difficulty rate in removing CBD stones in PAD was higher than in non-PAD group (35.3% vs 26.0%, P < 0.001). But the rate was no significant difference between the two groups in Kyoto center. The residual rates of choledocholithiasis were not significantly different between the two groups in both centers. Post-ERCP complications occurred in 8.9% of the PAD patients and 8.1% of the non-PAD patients in the Lanzhou Center, and it occurred in 5.8% in PAD patients and 10.0% in non-PAD patients in the Kyoto center, all P > 0.05.

CONCLUSION

Many clinical characteristics of choledocholithiasis patients with PAD were significantly different between the Lanzhou and Kyoto centers. The patients had larger and multiple stones, wider CBD diameter, and more possibility of acute cholangitis and obstructive jaundice in the Lanzhou center than those in the Kyoto center. The ERCP procedures to manage native duodenal papilla were different depending on the different clinical characteristics while the overall post-ERCP complications were not significantly different between the two centers. The stone residual rate and post-ERCP complications were not significantly different between choledocholithiasis patients with PAD and without PAD in each center.

Keywords: Clinical characteristics, Periampullary diverticulum, Endoscopic retrograde cholangiopancreatography, Choledocholithisasis

Core Tip: There were many studies on periampullary diverticulum (PAD) association with biliary stone and endoscopic retrograde cholangiopancreatography (ERCP) therapy. But many of them were from only single endoscopy center. In this article, the data from two centers of Lanzhou and Kyoto. We focused on comparing the choledocholithiasis characteristics with PAD, ERCP procedures and efficacy between the two centers. A total of 829 cases of choledocholithiasis with PAD in Lanzhou Center and 241 cases in Kyoto Center were involved. We find there are different characteristics of choledocholithiasis with PAD and different ERCP procedures to handle duodenal papilla between Lanzhou and Kyoto, and ERCP procedure depends on its own clinical characteristics.