Duodenal Diverticulum: A Predictor Of Failure Of Endoscopic Common Bile Duct Stone Extraction?

Aims An intra or para diverticular papilla can be a cause of endoscopic retrograde cholangiopancreatography (ERCP) failure during the treatment of common bile duct (CBD) stones. The objective of this study was to determine the impact of an intra or paradiverticular papilla on the cannulation of the papilla and on the extraction of stones.

Methods This is a retrospective study that included all patients who had ERCP for common bile duct stones between January 2014 and December 2017. Epidemiological, clinical and para-clinical data were collected. Univariate analysis was performed to determine whether an intra or para diverticular papilla was a cause of failure of papilla cannulation and stone extraction (SPSS software, p significant if <0.05).

Results We included 181 patients whose mean age was 64 years [22-103 years] with a sex ratio M/W = 0.41 . The main indications for ERCP were residual or recurrent lithiasis (69 %, n = 129) or sequential treatment (18 %, n = 33). The papilla was intra-diverticular in 4.4 % of cases and para-diverticular in 14.9 % of cases. Cannulation of the papilla by standard techniques could be performed in 127 patients (70.1 %). In univariate analysis an intra diverticular papilla (p = 0.807) and a para-diverticular papilla (p = 0.411) were not associated with a failure of the cannulation of the papilla. The clearance of the CBD was obtained in 61.5 % of cases. An intra-diverticular papilla was significantly associated with failure of stone extraction (p = 0.010). A para-diverticular papilla (p = 0.687) was not associated with failure of stone extraction.

Conclusions In our series, the intra or para-diverticular papilla was present in 19.3 % of cases. An intra-diverticular papilla is associated with failure of stone extraction. The use of second-line endoscopic techniques should be considered straight away in these patients

Citation Nakhli A, Sabbah M, Trad D et al. eP322 DUODENAL DIVERTICULUM: A PREDICTOR OF FAILURE OF ENDOSCOPIC COMMON BILE DUCT STONE EXTRACTION? Endoscopy 2021; 53: S203.

Publication History

Article published online:
19 March 2021