Effect Of Periampullary Diverticula On ERCP Treatment Of Common Bile Duct Stones

ObjectiveThe clinical data of patients with common bile duct stones and peripapillary duodenal diverticulum who underwent ERCP were retrospectively analyzed to explore the distribution characteristics of PAD in the population of patients with choledocholithiasis,the relationship between PAD and CBDS,and the effect of PAD on ERCP.MethodsA total of 205 patients admitted to our hospital for CBDS and receiving ERCP lithotomy from January 2021 to October 2022 were included and divided into the group with PAD and the group without PAD.Their medical history,clinical manifestations,auxiliary examination results and intraoperative operation records were sorted out and classified one by one,and then analyzed retrospectively by statistical methods.Furthermore,the distribution characteristics of PAD in the population of patients with choledocholithiasis were discussed,that is,whether the incidence of PAD was biased in terms of gender,age and other factors.The number of successful and difficult ERCP intubation cases was counted to further analyze whether PAD interfered with ERCP intubation.The effects of PAD on stone formation and ERCP were investigated by statistical analysis of bile duct diameter,stone size and number,and operation duration.The number of postoperative complications such as hyperamylasemia,pancreatitis and biliary tract infection in all cases were counted and analyzed to explore whether there was a relationship between PAD and ERCP postoperative complications.According to the reference standard of choledocholithiasis recurrence,all cases were divided into recurrent group and non-recurrent group,to explore the correlation between biliary tract operation history and PAD and stone recurrence.Results(1)In the population of patients with choledocholithiasis,the incidence of PAD was 47.4% in males and 33.0% in females(P < 0.05).(2)In the population of patients with choledocholithiasis,the incidence of PAD in patients younger than 39 years old was 8.0%.The incidence of PAD in 40-49 years old was 46.2%.The incidence of PAD in 50-59 years old was 28.6%.The incidence of PAD in 60-69 years old was 47.9%.The incidence of PAD in 70-79 years old was 48.0%.The incidence of PAD in 80-89 years old was 53.3%.The incidence of PAD in patients over90 years old was 75%(P < 0.05).(3)Successful intubation rate was 96.4% and difficult intubation rate was 3.6% in patients with PAD and 95.9% and 4.1% in patients without PAD(P > 0.05).(4)The inner diameter of common bile duct was 1.20(1.13-1.50)cm in the PAD group and 1.20(1.00-1.40)cm in the non-PAD group(P > 0.05).The diameter of the common bile duct was 1.05(0.80-1.50)cm in the PAD group and 1.00(0.65-1.50)cm in the non-PAD group(P > 0.05).In PAD group,the single common bile duct stone rate was46.4%,and the multiple common bile duct stone rate was 53.6%.In the non-PAD group,the single rate of common bile duct stones was 45.5%,and the multiple rate was 54.5%(P > 0.05).The operation time was 34.00(25.00-48.00)min in the PAD group and 30.00(25.00-39.50)min in the non-PAD group(P > 0.05).(5)The incidence of hyperamylasemia was 28.6% in patients with PAD and 28.1% in patients without PAD(P > 0.05).The incidence of postoperative pancreatitis was 11.9%in the PAD group and 14.0% in the non-PAD group(P > 0.05).The incidence of postoperative biliary tract infection was 8.3% in the PAD group and 4.1% in the non-PAD group(P> 0.05).(6)Recurrence rate of patients with biliary tract operation history was 73.8%,and recurrence rate of patients without biliary tract operation history was 0.6%(P < 0.001).The recurrence rate was 14.3% in patients with PAD and 16.5% in patients without PAD(P > 0.05).ConclusionIn the population of patients with choledocholithiasis,the incidence of PAD is related to gender and age,and it is more common in men and elderly people.For experienced operators,PAD does not affect the success rate of ERCP intubation.PAD had no significant effect on bile duct diameter,stone size and number,ERCP operation duration and postoperative complications,and there was no definite association between PAD and the recurrence of common bile duct stones.