Complications increase in which type of duodenal diverticulum? A retrospective cohort study

Abstract

Aim: In endoscopic retrograde cholangiopancreatography (ERCP), a diverticulum increases complications such as perforation and pancreatitis. We must know which type of diverticulum increases the complications to develop a strategy. The aim of this study is to examine the safety of the ERCP procedure in terms of diverticulum types. Methods: A total of 864 patients aged 65 years and over who underwent ERCP from January 2010 to November 2019 were identified and analyzed in this retrospective cohort study. Demographic findings, indications, successful cannulation rates and complications were compared between groups with and without duodenal diverticula. Results: Of the patients who underwent ERCP, 56.4% were female. The mean age of all patients was 77.39 (65-90) years. The most common indications were common bile duct stones (92.1%). Other indications included cholangitis (1.4%), sphincter Oddi dysfunction (1.6%), pancreatitis (2.1%), Mirizzi syndrome (2.7%), postoperative gallbladder fistula (0.7%), periampullary tumor formation (0.57%) and biliary stenosis (0.23%). Among all patients, 848 (98.1%) had no complications, 2 (0.34%) developed pancreatitis, 1 (0.17%) developed cholangitis and bleeding occurred in 1 (0.17%) patient in the group without a duodenal diverticulum. Among patients with a type I diverticulum, 4 (12.9%) had pancreatitis and 3 (9.6%) had bleeding. One patient (1.16%) had pancreatitis, 1 (1.16%) had cholangitis and 2 (2.33%) had bleeding among the type II group, while in the type III group, 1 (0.64%) had pancreatitis and 1(0.64%) had a perforation. Mortality was seen in 2 (0.23%) patients. A total of 5 (0.57%) periampullary tumors were detected in the study. Conclusion: Our study revealed that patients with a duodenal diverticulum experience more complications than the normal population. Among them, the rate is insignificantly increased in those with a type I duodenal diverticulum. Further studies are needed on this subject.

Keywords

• Endoscopic retrograde cholangiopancreatography
• duodenum
• diverticulum
• pancreatitis

Hangi duodenal divertikül tipinde komplikasyonlar artar? Retrospektif kohort çalışma

Öz

Amaç: ERCP prosedüründe divertikül oluşumu perforasyon ve pankreatit gibi komplikasyonları artırır. Hangi tip divertikülün komplikasyonları artırdığını bilmeli ve bunun için bir strateji geliştirebilmeliyiz. Bu çalışmanın amacı, ERCP işleminin güvenliğini divertikül türleri açısından incelemektir. Yöntemler: Ocak 2010'dan Kasım 2019'a kadar ERCP prosedürü uygulanan 65 yaş ve üstü 864 hasta retrospektif bir kohort çalışmasında belirlendi ve analiz edildi. Duodenal divertikülü olan ve olmayan gruplar arasında demografik bulgular, endikasyonlar, başarılı kanülasyon oranları ve komplikasyonlar karşılaştırıldı. Bulgular: ERCP uygulanan hastaların %56,4'ü kadındı. Tüm hastaların ortalama yaşı 77,39 (65-90) yıldı. En yaygın endikasyonlar %92,1 ile safra kanalı taşlarıdır. Diğer endikasyonlar arasında %1,4 kolanjit, %1,6 sfinkter Oddi disfonksiyonu, %2,1 pankreatit, %2,7 Mirizzi sendromu, %0,7 postoperatif safra kesesi fistülü, %0,57 periampullar tümör oluşumu ve %0,23 ile safra darlığıdır. 864 hastanın 848'inde (%98,1) komplikasyon görülmedi. Duodenal divertikülü olmayan grupta 2 (%0,34) pankreatit, 1 (%0,17) kolanjit ve 1 (%0,17) kanama meydana geldi. Tip I grupta 4 (%12,9) hastada pankreatit ve 3 (%9,6) hastada kanama görüldü. Tip II grupta 1 (%1,16) hastada pankreatit, 1 (%1,16) hastada kolanjit ve 2 (%2,33) hastada kanama meydana geldi. Tip III grupta 1 (%0,64) hastada pankreatit ve 1 (%0,64) hastada perforasyon gelişti. Mortalite 2 (%0,23) hastada görüldü. Çalışmada toplam 5 (%0,57) hastada periampuller tümör tespit edildi. Sonuç: Sonuç olarak, bu çalışmada duodenal divertikülü olan hastaların normal popülasyona göre daha fazla komplikasyon yaşadıkları gösterilmiştir. Ancak duodenal divertikül tipleri arasında özellikle tip 1 duodenal divertikülü olanların daha fazla komplikasyon yaşadığı görüldü, ancak istatistiksel olarak anlamlı değildi. Bu durum bize bu konuda yeni çalışmalara ihtiyaç olduğunu gösteriyor.

Anahtar Kelimeler

• Endoskopik retrograd kolanjiyopankreatografi
• duodenal
• divertikül
• pankreatit

Kaynakça

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