The following is a summary of “A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging,” published in the July 2023 issue of Gastroenterology by Shi et al.
Researchers performed a retrospective study on Periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) in choledocholithiasis patients.
They compared outcomes in patients with and without PAD and those with 4 PAD types. The first one was a papilla completely inside the diverticulum (type I), the second papilla in the inner margin of the diverticulum (type IIa), then a papilla in the outer margin of the diverticulum (type IIb), and the last papilla outside the diverticulum (type III). Compared parameters such as cannulation time, difficult cannulation rates, post-ERCP pancreatitis (PEP), and perforation.
The results revealed that patients with types I, IIa, IIb, and III PAD and without PAD had median cannulation times of 2.0 min, 5.0 min, 0.67 min, 3.5 min, and 3.5 min, respectively. Difficult cannulation rates: 7.4%, 31.4%, 8.3%, 18.9%, 23.2%. Rates of PEP in patients with and without PAD were 5.3% and 5.1%, respectively. Perforation occurred in 4 patients with PAD and one patient without PAD.
Investigators concluded that dividing PAD into 4 types is better than 3. Type I and II b PAD are easier to cannulate than patients without PAD, but type II a is more challenging. PAD may not raise PEP rates.