The Risk Analysis For ERCP Of Periampullary Diverticula With Pancr-eaticobiliary Diseases

Background:Some studies think that the patients of PAD(periampullary diverticula,PAD)is easy to compilcate the pancreaticobiliary disease,others think the PAD has no effect on the pancreaticobiliary disease,which is a controversy.In patients with pancreaticobiliary disease that undergo an ERCP(endoscopic retrograde cholangiopancreatography,ERCP),1-27% of them have PAD,therefore Whether the existence of the PAD improves the difficulty of ERCP may have an effect on the surgical success rate of ERCP and the surgical complication incidence of ERCP,Which has become one of the present studying hot spots.Objective:Our purpose is to analyse the relationship among the PAD and biliary calculi,suppurative cholangitis,acute pancreatitis,chronic pancreatitis,pancreaticobiliary malignant tumor and so on and study whether the existence of the PAD has an effect on the surgical success rate of ERCP and the surgical complication incidence of ERCP.Methods:We divided patients in our hosptial that underwent an endoscopic retrograde cholangiopancreatography in 2015 into the diverticulum group and the non diverticulum group according to whether there was diverticulum,and retrospectively analysed the incidence of pancreaticobiliary disease,surgical success rate of ERCP,and surgical incidence of complication of ERCP.Results:We have collected 1455 patients in total,including the diverticulum group 293 cases,the non diverticulum group 1162 cases,and the detection rate of PAD was20.14%.The diverticulum group had male 152 and female 141,and their average age was 66 years old;The non diverticulum group had male 576 and female 586,and their average age was 54 years old.The diverticulum group had 240 cases of biliary calculi patients,including 58 cases of gallbladder stone with common bile ductcalculi,112 cases of primary common bile duct calculi,70 cases with common bile duct stones after cholecystectomy;The non diverticulum group had 871 cases of biliary calculi patients,including 325 cases of gallbladder stone with common bile duct calculi,300 cases of primary common bile duct calculi,246 cases with common bile duct stones after cholecystectomy;The biliary calculi incidence of the diverticulum group was higher than the non diverticulum group(81.91%>74.96%),and the primary common bile duct calculi incidence of the diverticulum group was higher than the non diverticulum group(38.23% > 25.82%),but the common bile duct stones after cholecystectomy incidence of the diverticulum group was lower than the non diverticulum group(19.80% < 27.97%),and all P value was less than 0.05 which has statistical significance.Two groups' suppurative cholangitis rate was19.11% and 10.93% respectively,and the incidence of acute pancreatitis was 22.53%and 7.92% respectively,and the incidence of pancreatic head carcinoma was 4.78%and 2.32% respectively,even all of them had statistically difference(P < 0.05).The surgical success rate of ERCP between the two groups was 98.98% and 98.97%respectively,and there was no statistical significance.The diverticulum group had 21(7.17%)cases of gastrointestinal bleeding,3(1.02%)cases of gastrointestinal perforation,24(8.19%)cases of PEP(post-endoscopic retrograde cholangiopancreatography pancreatitis,PEP),and 35(11.95%)cases of PEPH(post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia,PEPH);The non diverticulum group had 46(3.96%)cases of gastrointestinal bleeding,1(0.09%)case of gastrointestinal perforation,30(2.58%)cases of PEP,and 81(6.97%)cases of PEPH;There was statistical difference in both groups(P < 0.05).Conclusions:The patients of PAD is easy to compilcate the pancreaticobiliary disease.PAD can improve the surgical complication incidence of ERCP,although PAD has no effect on the surgical success rate of ERCP.