H. Mehmet SÖKMEN, Kamil ÖZDİL, Abdurrahman ŞAHİN, Resul KAHRAMAN, Bilgehan YÜZBAŞIOĞLU, Turan ÇALHAN, Hakan DEMİRDAĞ, Adil NİĞDELİOĞLU

Periampuller divertikül ERCP'de pankreatiti artırır kanamayı arttırmaz

Giriş ve Amaç: Periampuller divertiküllü hastalarda endoskopik retrograd kolanjiopankreatikografi işleminin normal hastalara göre daha zor ve komplikasyon açısından daha riskli olduğu sanılmaktadır. Genelde, endoskopik retrograd kolanjiopankreatikografi yapılan hastalarda periampuller divertikül prevelansı %5-32 arasında saptanmıştır. Çalışmamızda, çeşitli nedenlerle endoskopik retrograd kolanjiopankreatikografi endikasyonu konan hastalarımızda periampuller divertikül sıklığı ve periampuller divertikülün endoskopik retrograd kolanjiopankreatikografi yapılan hastalarda komplikasyon oranlarını artırıp arttırmadığının retrospektif değerlendirilmesi amaçlandı. Gereç ve Yöntem: Temmuz 2009 ile Ekim 2010 arasında ünitemizde yapılan endoskopik retrograd kolanjiopankreatikografi işlemleri retrospektif olarak değerlendirildi. Endoskopik retrograd kolanjiopankreatikografi yapılan hastalar periampuller divertikül bulunup bulunmamasına göre iki gruba ayrıldı. Periampuller divertikül mevcudiyetine göre endoskopik retrograd kolanjiopankreatikografi komplikasyonları değerlendirildi. Bulgular: Çeşitli nedenlerle endoskopik retrograd kolanjiopankreatikografi yapılan 216 hastanın 31'inde (%14,6) periampuller divertikül vardı. Bu hastalara yapılan toplam 258 işlem değerlendirmeye alındı. Periampuller divertikülü olan hastaların ortalama yaşı (71.4±12.4 yıl), periampuller divertikülü olmayan hastalardan (58.3±17.3 yıl) yüksekti (p

Anahtar Kelimeler:

Periampuller divertikül, endoskopik retrograd kolanjiopankreatikografi, komplikasyon

Periampullary diverticula increase post-ERCP pancreatitis, but not bleeding

Background/aims: It is suggested that the endoscopic retrograde cholangiopancreatography procedure is more difficult and carriers higher risk of complication in patients with periampullary diverticula than in normal subjects. Prevalence of periampullary diverticula is 5% to 32% in patients who undergo endoscopic retrograde cholangiopancreatography. In this study, we aimed to investigate the prevalence of periampullary diverticula in patients who underwent endoscopic retrograde cholangiopancreatography for various indications and the impact of periampullary diverticula on the complications of endoscopic retrograde cholangiopancreatography. Materials and Methods: Consecutive endoscopic retrograde cholangiopancreatography procedures in our endoscopy unit performed between July 2009 and October 2010 were evaluated retrospectively. Patients who underwent an endoscopic retrograde cholangiopancreatography were divided into two groups according to the presence or not of periampullary diverticula. The complications were evaluated according to the presence of periampullary diverticula. Results: Periampullary diverticula were present in 31 (14.6%) of the 213 patients undergoing endoscopic retrograde cholangiopancreatography for various indications. A total of 258 procedures were evaluated. The mean age was significantly higher in patients with periampullary diverticula (71.4±12.4 years) than in the control group (58.3±17.3 years) (p

Keywords:

Periampullary diverticula, endoscopic retrograde cholangiopancreatography, complication,

PDF

___

Kirk AP, Summerfield JA. Incidence and significance of juxtapapillary diverticula at endoscopic retrograde cholangiopancreatography. Digesti- on 1980; 20: 31-5.
Panteris V, Vezakis A, Filippou G, et al. Influence of juxtapapillary diver- ticula on the success or difficulty of cannulation and complication rate Gastrointest Endosc 2008; 68: 903-10.
Chang-Chien CS. Do juxtapapillary diverticula of the duodenum inter- fere with cannulation at endoscopic retrograde cholangiopancreatog- raphy? A prospective study. Gastrointest Endosc 1987; 33: 298-300.
Boix J, Lorenzo-Zşñiga V, Añaños F, et al. Impact of periampullary du- odenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg La- parosc Endosc Percutan Tech 2006; 16: 208-11.
Zoepf T, Zoepf DS, Arnold JC, et al. The relationship between juxtapa- pillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients. Gastrointest Endosc 2001; 54: 56-61.
Macari M, Lazarus D, Israel G, Megibow A. Duodenal diverticula mimic- king cystic neoplasms of the pancreas: CT and MR imaging findings in seven patients. AJR Am J Roentgenol 2003; 180: 195-9.
Tsitouridis I, Emmanouilidou M, Goutsaridou F, et al. MR cholangiog- raphy in the evaluation of patients with duodenal periampullary diverti- culum. Eur J Radiol 2003; 47: 154-60.
Kim MH, Myung SJ, Kim YS, et al. Routine biliary sphincterotomy may not be indispensable for endoscopic pancreatic sphincterotomy. Endos- copy 1998; 30: 697-701.
Kim MH, Myung SJ, Seo DW, et al. Association of periampullary diver- ticula with primary choledocholithiasis but not with secondary chole- docholithiasis. Endoscopy 1998; 30: 601-4.
Lobo DN, Balfour TW, Iftikhar SY. Periampullary diverticula: consequ- ences of failed ERCP. Ann R Coll Surg Engl 1998; 80: 326-31.
Tyagi P, Sharma P, Sharma BC, Puri AS. Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography. Surg Endosc 2009; 23: 1342-5.
Leivonen MK, Halttunen JA, Kivilaakso EO. Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of 123 pati- ents. Hepatogastroenterology 1996; 43): 961-6.
Williams EJ, Green J, Beckingham I, et al. Guidelines on the manage- ment of common bile duct stones (CBDS). Gut 2008; 57: 1004-21.
Tham TC, Kelly M. Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrogra- de cholangiopancreatography. Endoscopy 2004; 36: 1050-3.
Shemesh E, Klein E, Czerniak A, et al. Endoscopic sphincterotomy in pa- tients with gallbladder in situ: the influence of periampullary duodenal diverticula. Surgery 1990; 107: 163-6.
Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48: 1-10.