Preprint Article Version 2 Preserved in Portico This version is not peer-reviewed

Impact of Periampullary Diverticulum on Biliary Cannulation and ERCP Outcomes: A Single-Center Prospective Study

Version 1 : Received: 7 January 2020 / Approved: 9 January 2020 / Online: 9 January 2020 (07:57:56 CET)
Version 2 : Received: 16 January 2020 / Approved: 17 January 2020 / Online: 17 January 2020 (04:12:23 CET)

A peer-reviewed article of this Preprint also exists.

Tabak, F., Ji, G. & Miao, L. Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: a single-center experience. Surg Endosc (2020). Tabak, F., Ji, G. & Miao, L. Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: a single-center experience. Surg Endosc (2020).


Aim: This study aimed to investigate the association between periampullary diverticulum (PAD) and difficult biliary cannulation, as well as to evaluate the impact of different types of PAD on the cannulation success rate and adverse events. Methods: A total of 636 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) during the study period were prospectively studied and divided into two groups based on the presence or absence of PAD. In group A, 126 patients had PAD compared with 510 patients in group B without PAD. The primary outcome measurements were ERCP procedures time, selective cannulation techniques, and cannulation difficulty in addition to cannulation success rate and ERCP-related adverse events. The difficult cannulation was analyzed using logistic regression considering age, co-morbidities, the presence of PAD types, and indications as independent factors. Results: The average cohort age was 65.30±16.67 years, and 52.7% were male. Significant higher rates of choledocholithiasis, cholangitis, and biliary pancreatitis were reported in the group of PAD (p<0.05). Successful selective cannulation was achieved in 97.6% in group A and 95.3% in group B (p>0.05). The cannulation time was significantly longer in the presence of PAD (5.1 min, vs. 4.09 min, p<0.05). There was no significant difference in the rate of overall adverse events and post ERCP pancreatic PEP. Conclusion: The presence of PAD did not affect the duration or success of the ERCP procedure. Furthermore, it was associated with longer cannulation time and increase in the cannulation difficulty, especially with PAD type 1.


endoscopic retrograde cholangiopancreatography; periampullary diverticulum; difficult cannulation; biliary cannulation; cannulation techniques; adverse events


Medicine and Pharmacology, Gastroenterology and Hepatology

Comments (1)

Comment 1
Received: 17 January 2020
Commenter: Fatema Tabak
Commenter's Conflict of Interests: Author
Comment: We added a new figure (Figure 2) to the text. Also, we updated some references. Some small modifications and English proof also are done.
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