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
Processing time: 308 Days and 3 Hours
ARTICLE HIGHLIGHTS
Research 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 there were inconsistent conclusions of the PAD impacts on safety and post ERCP complications for choledocholithiasis.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.