ISSN: 1859 - 2872
Endoscopic retrograde cholangiopancreatography (ERCP) in patient with periampullary diverticulum: Report of two cases of papillary cannulation assisted by clips
Main Article Content
Keywords
Periampullary diverticulum, PAD, endoclip-assisted biliary cannulation
Abstract
Periampullary diverticulum (PAD) typically appears in older adults and is often incidentally discovered during endoscopic retrograde cholangiopancreatography (ERCP). PAD usually presents without symptoms, but it is a risk factor for the formation of bile duct stones. PAD can complicate ERCP procedures by increasing the duration of cannulation and the likelihood of difficult cannulation. We report two clinical cases where ERCP intervention revealed periampullary diverticulum, with the papilla located in an unfavorable position for cannulation. We proceeded to use clips to reposition the papilla, which facilitated successful cannulation. This intervention method is relatively easy to perform and effective for difficult cannulation cases caused by PAD.
Article Details
References
1. Altonbary AY, Bahgat MH (2016) Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation. World J Gastrointest Endosc 8(6): 282-287. doi:10.4253/wjge.v8.i6.282.
2. Lobo DN, Balfour TW, Iftikhar SY (1998) Periampullary diverticula: Consequences of failed ERCP. Ann R Coll Surg Engl 80(5): 326-331.
3. Chen L, Xia L, Lu Y, Bie L, Gong B (2017) Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 29(1): 105-111. doi:10.1097/MEG.0000000000000744.
4. Mohammad Alizadeh AH, Afzali ES, Shahnazi A et al (2013) ERCP features and outcome in patients with periampullary duodenal diverticulum. ISRN Gastroenterol 217261. doi:10.1155/2013/217261.
5. Tabak F, Ji GZ, Miao L (2021) Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: A single-center experience. Surg Endosc 35(11) :5953-5961. doi:10.1007/s00464-020-08080-8.
6. Hu Y, Kou DQ, Guo SB (2020) The influence of periampullary diverticula on ERCP for treatment of common bile duct stones. Sci Rep 10(1):11477. doi:10.1038/s41598-020-68471-8.
7. Inoue R, Kawakami H, Kubota Y, Ban T (2019) Endoscopic biliary intervention using traction devices for periampullary diverticulum. Intern Med 58(19): 2797-2801. doi:10.2169/internalmedicine.2804-19.
8. Boix J, Lorenzo-Zuniga V, Ananos F, Domenech E, Morillas RM, Gassull MA (2006) Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: A proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech 16(4): 208-211. doi:10.1097/00129689-200608000-00002.
9. Tyagi P, Sharma P, Sharma BC, Puri AS Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc 23(6): 1342-1345. doi:10.1007/s00464-008-0167-7.
10. Oddo F, Chevallier P, Souci J et al (1999) Radiologic aspects of the complications of duodenal diverticula. J Radiol 80(2): 134-140.
11. Yoneyama F, Miyata K, Ohta H, Takeuchi E, Yamada T, Kobayashi Y (2004) Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: Report of three cases. J Hepatobiliary Pancreat Surg 11(1): 69-72. doi:10.1007/s00534-003-0854-7.
12. Panteris V, Vezakis A, Filippou G, Filippou D, Karamanolis D, Rizos S (2008) Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate. Gastrointest Endosc 68(5):903-910. doi:10.1016/j.gie.2008.03.1092.
13. Yildirgan MI, Basoglu M, Yilmaz I et al Periampullary diverticula causing pancreaticobiliary disease. Dig Dis Sci 9(11-12): 1943-1945. doi:10.1007/s10620-004-9597-9.
14. Hagege H, Berson A, Pelletier G et al (1992) Association of juxtapapillary diverticula with choledocholithiasis but not with cholecystolithiasis. Endoscopy 24(4): 248-251. doi:10.1055/s-2007-1010476.
15. Miyazaki S, Sakamoto T, Miyata M, Yamasaki Y, Yamasaki H, Kuwata K (1995) Function of the sphincter of Oddi in patients with juxtapapillary duodenal diverticula: Evaluation by intraoperative biliary manometry under a duodenal pressure load. World J Surg 19(2): 307-312. doi:10.1007/BF00308647.
16. Shinagawa N, Fukui T, Mashita K, Kitano Y, Yura J (1991) The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile. Jpn J Surg 21(3): 284-291. doi:10.1007/BF02470948.
17. Rajnakova A, Goh PM, Ngoi SS, Lim SG (2003) ERCP in patients with periampullary diverticulum. Hepatogastroenterology 50(51): 625-628.
18. Kennedy RH, Thompson MH (1988) Are duodenal diverticula associated with choledocholithiasis? Gut 29(7): 1003-1006. doi:10.1136/gut.29.7.1003.
19. Shi HX, Ye YQ, Zhao HW et al (2023) A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging. BMC Gastroenterol 23(1):252. doi:10.1186/s12876-023-02862-9.
20. Todd H. Baron M, FASGE (2015) Cannulation of the Major Papilla. ERCP third editon: 108-122.
2. Lobo DN, Balfour TW, Iftikhar SY (1998) Periampullary diverticula: Consequences of failed ERCP. Ann R Coll Surg Engl 80(5): 326-331.
3. Chen L, Xia L, Lu Y, Bie L, Gong B (2017) Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 29(1): 105-111. doi:10.1097/MEG.0000000000000744.
4. Mohammad Alizadeh AH, Afzali ES, Shahnazi A et al (2013) ERCP features and outcome in patients with periampullary duodenal diverticulum. ISRN Gastroenterol 217261. doi:10.1155/2013/217261.
5. Tabak F, Ji GZ, Miao L (2021) Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: A single-center experience. Surg Endosc 35(11) :5953-5961. doi:10.1007/s00464-020-08080-8.
6. Hu Y, Kou DQ, Guo SB (2020) The influence of periampullary diverticula on ERCP for treatment of common bile duct stones. Sci Rep 10(1):11477. doi:10.1038/s41598-020-68471-8.
7. Inoue R, Kawakami H, Kubota Y, Ban T (2019) Endoscopic biliary intervention using traction devices for periampullary diverticulum. Intern Med 58(19): 2797-2801. doi:10.2169/internalmedicine.2804-19.
8. Boix J, Lorenzo-Zuniga V, Ananos F, Domenech E, Morillas RM, Gassull MA (2006) Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: A proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech 16(4): 208-211. doi:10.1097/00129689-200608000-00002.
9. Tyagi P, Sharma P, Sharma BC, Puri AS Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc 23(6): 1342-1345. doi:10.1007/s00464-008-0167-7.
10. Oddo F, Chevallier P, Souci J et al (1999) Radiologic aspects of the complications of duodenal diverticula. J Radiol 80(2): 134-140.
11. Yoneyama F, Miyata K, Ohta H, Takeuchi E, Yamada T, Kobayashi Y (2004) Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: Report of three cases. J Hepatobiliary Pancreat Surg 11(1): 69-72. doi:10.1007/s00534-003-0854-7.
12. Panteris V, Vezakis A, Filippou G, Filippou D, Karamanolis D, Rizos S (2008) Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate. Gastrointest Endosc 68(5):903-910. doi:10.1016/j.gie.2008.03.1092.
13. Yildirgan MI, Basoglu M, Yilmaz I et al Periampullary diverticula causing pancreaticobiliary disease. Dig Dis Sci 9(11-12): 1943-1945. doi:10.1007/s10620-004-9597-9.
14. Hagege H, Berson A, Pelletier G et al (1992) Association of juxtapapillary diverticula with choledocholithiasis but not with cholecystolithiasis. Endoscopy 24(4): 248-251. doi:10.1055/s-2007-1010476.
15. Miyazaki S, Sakamoto T, Miyata M, Yamasaki Y, Yamasaki H, Kuwata K (1995) Function of the sphincter of Oddi in patients with juxtapapillary duodenal diverticula: Evaluation by intraoperative biliary manometry under a duodenal pressure load. World J Surg 19(2): 307-312. doi:10.1007/BF00308647.
16. Shinagawa N, Fukui T, Mashita K, Kitano Y, Yura J (1991) The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile. Jpn J Surg 21(3): 284-291. doi:10.1007/BF02470948.
17. Rajnakova A, Goh PM, Ngoi SS, Lim SG (2003) ERCP in patients with periampullary diverticulum. Hepatogastroenterology 50(51): 625-628.
18. Kennedy RH, Thompson MH (1988) Are duodenal diverticula associated with choledocholithiasis? Gut 29(7): 1003-1006. doi:10.1136/gut.29.7.1003.
19. Shi HX, Ye YQ, Zhao HW et al (2023) A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging. BMC Gastroenterol 23(1):252. doi:10.1186/s12876-023-02862-9.
20. Todd H. Baron M, FASGE (2015) Cannulation of the Major Papilla. ERCP third editon: 108-122.