Impact of periampullary diverticulum on endoscopic retrograde cholangiopancreatography: bridging the gap between fiction and reality

Introduction
Periampullary diverticulum (PAD) is frequently discovered in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Studies have yielded conflicting results regarding its impact on the technical success of ERCP and post-ERCP complications.

Aim
This study aims to assess the success and safety of ERCP in patients with PAD.

Material and methods
This study included 400 patients who underwent ERCP for common bile duct (CBD) stones. Patients were classified into the PAD group (200 patients) and the non-PAD group (200 patients). Within the PAD group, patients were further subclassified into three types based on the location of the papilla. The study compared the two groups in terms of technical success and ERCP complications.

Results
The success rate of cannulation using selective techniques, needle-knife precut, or trans-pancreatic sphincterotomy was 88%, 7.5%, and 4.5%, respectively, for the PAD group and 81%, 9.5%, and 9.5%, respectively, for the non-PAD group (p = 0.099). Complete CBD clearance was achieved in 85% of the PAD group and 84% of the non-PAD group (p = 0.782). The rate of post-ERCP complications was similar in both groups (p = 0.371). Periampullary diverticulum type 1 was associated with more challenging cannulation (p < 0.001), a lower rate of complete CBD clearance (p < 0.001), and a higher rate of post-ERCP pancreatitis (p = 0.002) compared to other types.

Conclusions
The presence of PAD does not hinder the technical success of ERCP and is not associated with a higher frequency of post-ERCP complications.