Published online Feb 27, 2022. doi: 10.4240/wjgs.v14.i2.132
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
Most of study regarding periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) therapy for choledocholithiasis based on data from one endoscopy center and there were inconsistent conclusions of the PAD impacts on safety and post ERCP complications for choledocholithiasis.
What did cause the different conclusions of PAD impacts on post ERCP complications and safety for choledocholithiasis? UP to now, the real reason is little known and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical endoscopy centers.
To compare the clinical characteristics of choledocholithiasis with PAD between two regional endoscopy centers and analyze the efficacy of clinical characteristics on ERCP procedures for choledocholithiasis patients with PAD.
Patients underwent ERCP treatment at first time between January 2012 and December 2017 were Involved. The clinical characteristics and ERCP related contents of choledocholithiasis with PAD were compared between Lanzhou center and Kyoto center. Furthermore, Choledocholithiasis without PAD as control, analyzed the clinical characteristic and ERCP therapy of Choledocholithiasis with PAD internal each center.
829 out of 3608 patients in Lanzhou center and 241 out of 1198 in Kyoto center suffered from choledocholithiasis with PAD. The overall clinical characteristics were significantly different excepting the gender between the two centers. Non-PAD choledocholithiasis as control, in Lanzhou center, many clinical characteristics of patients were significant difference between non-PAD and PAD (P = 0.03 - <0.001), but were no difference in Kyoto center (each with P > 0.05).
For choledocholithiasis with PAD patients, ERCP procedures to handle the duodenal papilla were significant different Lanzhou center and Kyoto center (P < 0.001). But the overall post-complication was no significant different between two centers (8.9% in Lanzhou center, 5.8% in Kyoto center. P = 0.12).
The difficult rate to remove stone, in Lanzhou center, was 35.3% and 26.0% in PAD group and non-PAD group, with a significant difference between two groups (P < 0.001), while it accounted for 53.8% and 53.3% in PAD group and non-PAD group in Kyoto center, with no significant difference between two groups. However, residual rate of choledocholithisasis was no significant difference between two groups in each center. Meanwhile, there were also no significant differences of post-ERCP complications between PAD and non-PAD patients within each center.
Many clinical characteristics of choledocholithiasis patients with PAD were significant difference between Lanzhou and Kyoto. Patients carried characteristics with larger and multiple stones, wider diameter of CBD, and more possibility of acute cholangitis and obstructive jaundice in Lanzhou center than those in Kyoto. ERCP procedures to cope with native duodenal papilla were different between Lanzhou and Kyoto, depended on its own different clinical characteristics of choledocholithiasis with PAD. The efficacy and post-ERCP complications were no significant differences for choledocholithiasis with PAD in each own center. The overall post-ERCP complication was no statistics difference between two centers as well.
The control study of multiple endoscopy centers from different region is worthy of conducting to uncover the characteristics of choledocholithiasis patients with PAD and their influences on therapy ERCP. The role of different ERCP procedures for recurrence of choledocholithiasis need to be confirmed through further subsequent research or prospective studies.