Periampüller divertikül endoskopik retrograd kolanjiyopankreatografide kanülasyon başarısı ve komplikasyon sıklığını etkiler mi?

Öz

Giriş ve Amaç: Periampüller divertiküller, endoskopik retrograd kolanjiyopankreatografi işlemi esnasında özellikle yaşlı hastalarda sık rastlanan anomalilerdir. Periampüller divertiküllerin endoskopik retrograd kolanjiyopankreatografide teknik başarı ve komplikasyonlar üzerine etkisi ile ilgili yapılan çalışmaların sonuçları ise çelişkilidir. Çalışmamızda periampüller divertikülü olan ve olmayan hastalar arasında endoskopik retrograd kolanjiyopankreatografi işlemi esnasında kanülasyon başarısı ve erken komplikasyonları karşılaştırmayı ve bunları etkileyen faktörleri değerlendirmeyi amaçladık. Gereç ve Yöntem: 2018-2020 yılları arasında endoskopik retrograd kolanjiyopankreatografi yapılan hastalar retrospektif olarak çalışmaya alındı. Hastalar periampüller divertikülü olmayan (n=574) ve olan (n=137) şeklinde iki gruba ayrıldı. Hastaların tıbbi kayıtları incelenerek her iki grup demografik ve klinik özellikleri, endoskopik retrograd kolanjiyopankreatografi işlem özellikleri, komplikasyon ve mortalite oranları açısından karşılaştırıldı. Bulgular: Ortalama yaşı 61.2±17.7, 465’i (%57.3) kadın olan 811 hastaya yapılan toplam 973 endoskopik retrograd kolanjiyopankreatografi işlemi incelendi. Kanülasyon başarısı periampüller divertikülü olmayan grupta %97, periampüller divertikülü olan grupta %97.1 (p=0.96) saptandı. Endoskopik retrograd kolanjiyopankreatografide seans sayısı, işlem başarısı, koledok taşı varlığı, taş çıkarmak için büyük balon ile papilla dilatasyon ihtiyacı ve biliyer stent konulma oranları açısından gruplar benzerdi (p >0.05). Periampüller divertikül bulunmayan grupta kanülasyon için ön kesi ihtiyacı daha yüksekti (sırasıyla; %25 vs %14.6, p=0.01). Endoskopik retrograd kolanjiyopankreatografiye bağlı erken komplikasyonlar açısından ise gruplar arasında farklılık saptanmadı (periampüller divertikülü olmayanlarda n=21, %3.1, periampüller divertikülü olanlarda n=5, %3.6, p=0.75). Sonuç: Endoskopik retrograd kolanjiyopankreatografi esnasında periampüller divertikül saptanması kanülasyon önünde bir engel olarak görülmemeli, hatta ön kesi ihtiyacını azaltarak kanülasyonu kolaylaştırabileceği dikkate alınmalıdır. Çalışmamızın sonuçları periampüller divertiküllerin varlığının işleme bağlı komplikasyonlar açısından ek risk oluşturmadığını göstermektedir.

Anahtar Kelimeler

• Endoskopik retrograd kolanjiyopankreatografi,
• periampüller divertikül,
• duodenal divertikül,

Do periampullary diverticula affect cannulation success and frequency of complications in endoscopic retrograde cholangiopancreatography?

Öz

Background and Aims: Periampullary diverticulas are frequent anomalies found during endoscopic retrograde cholangiopancreatography, especially in elderly patients. Previous study results on the effect of periampullary diverticula on technical success and complications in endoscopic retrograde cholangiopancreatography are controversial. In this study, we aimed to compare the cannulation success rate and early complications between patients with and without periampullary diverticula during endoscopic retrograde cholangiopancreatography, and to evaluate the factors affecting them. Material and Methods: Patients who underwent endoscopic retrograde cholangiopancreatography between 2018 and 2020 were retrospectively included in the study. The patients were divided into two groups: patients with periampullary diverticula (n = 137) and patients without periampullary diverticula (n = 574). Patients’ medical records were analyzed, and the groups were compared in terms of dermographic and clinical features, cannulation success, need for precut sphincterotomy, balloon-papilla dilatation, biliary stent placement, the number of endoscopic procedures, complications, and mortality. Results: A total of 973 endoscopic retrograde cholangiopancreatography procedures were performed on 811 patients (465 [57.3%] women). The mean patient age was 61.2 ± 17.7 years. The cannulation success rate was 97% in the non- periampullary diverticula group and 97.1% (p = 0.96) in the periampullary diverticula group. The groups were similar in terms of the number of endoscopic retrograde cholangiopancreatography sessions, the success rate of the procedure, the presence of choledocolitiazis, the need for balloon-papilla dilatation, and biliary stent placement rates (p > 0.05). The need for precut sphincterotomy was higher in the non- periampullary diverticula group (25% vs. 14.6%, respectively; p = 0.01). There was no difference between the groups in terms of early complications related to endoscopic retrograde cholangiopancreatography (21 [3.1%] in the non- periampullary diverticula group, and 5 [3.6%] in the periampullary diverticula group; p = 0.75). Conclusion: Periampullary diverticula detection during endoscopic retrograde cholangiopancreatography should not be considered an obstacle for cannulation success, and it can help facilitate the cannulation by reducing the need for precut sphincterotomy. The results of our study show that the presence of periampullary diverticula also does not increase the risk of procedure-related complications.

Anahtar Kelimeler

• Endoscopic retrograde cholangiopancreatography,
• periampullary diverticulum,
• duodenal diverticulum,

Kaynakça

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