Impact of periampullary diverticula on the rates of successful cannulation and ERCP complications: An up-to-date systematic review and meta-analysis

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Journal of Digestive Diseases Pub Date : 2024-11-18 DOI:10.1111/1751-2980.13315

Xiao Xi Xie, Xiao Li, Yong Hao Chen, Chong Geng, Chun Hui Wang

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Abstract

Objectives

Periampullary diverticulum (PAD) is usually incidentally discovered during abdominal imaging, gastrointestinal endoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). The influence of PAD on ERCP outcomes is unclear. The aim of this systematic review and meta-analysis was to provide an up-to-date evaluation of the impact of PAD on cannulation and ERCP-related complications.

Methods

PubMed, Web of Science, Cochrane Library and EMBASE databases were searched for relevant articles published up to October 31, 2023. The rates of successful cannulation and post-ERCP complications were compared between the PAD and non-PAD groups. The quality of the studies was evaluated with the Newcastle-Ottawa Scale (NOS). The meta-analysis was conducted using Review Manager 5.3.

Results

Twenty-eight articles were included. Non-PAD was associated with a relatively high cannulation success rate (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.54–0.97, p = 0.03). However, after 2015, PAD was not correlated with cannulation failure (OR 0.81, 95% CI 0.59–1.11, p = 0.20). Compared with intradiverticular papilla (IDP), non-IDP had a higher successful cannulation rate (OR 0.42, 95% CI 0.25–0.72, p = 0.002), while IDP increased the difficult cannulation rate (OR 1.60, 95% CI 1.05–2.44, p = 0.03). Additionally, PAD increased the incidence of ERCP-related pancreatitis (OR 1.24, 95% CI 1.10–1.40, p = 0.0006) and bleeding (OR 1.34, 95% CI 1.03–1.73, p = 0.03).

Conclusions

Although PAD, especially IDP, decreased the cannulation success rate, PAD was no longer considered a significant obstacle to cannulation after 2015. PAD increased the incidence of post-ERCP pancreatitis and bleeding.

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胰周憩室对插管成功率和ERCP并发症的影响：最新系统综述和荟萃分析。

目的：胰周憩室（PAD）通常是在腹部成像、消化内镜检查和内镜逆行胰胆管造影术（ERCP）中偶然发现的。PAD对ERCP结果的影响尚不清楚。本系统综述和荟萃分析旨在对 PAD 对插管和 ERCP 相关并发症的影响进行最新评估：方法：检索了 PubMed、Web of Science、Cochrane Library 和 EMBASE 数据库中截至 2023 年 10 月 31 日发表的相关文章。比较了PAD组和非PAD组的插管成功率和ERCP术后并发症的发生率。研究质量采用纽卡斯尔-渥太华量表（NOS）进行评估。使用 Review Manager 5.3 进行了荟萃分析：结果：共纳入 28 篇文章。非 PAD 与相对较高的插管成功率相关（几率比 [OR] 0.72，95% 置信区间 [CI]0.54-0.97，P = 0.03）。但在 2015 年之后，PAD 与插管失败无关（OR 0.81，95% CI 0.59-1.11，p = 0.20）。与椎管内乳头（IDP）相比，非IDP的插管成功率更高（OR 0.42，95% CI 0.25-0.72，p = 0.002），而IDP增加了插管困难率（OR 1.60，95% CI 1.05-2.44，p = 0.03）。此外，PAD 增加了 ERCP 相关胰腺炎（OR 1.24，95% CI 1.10-1.40，p = 0.0006）和出血（OR 1.34，95% CI 1.03-1.73，p = 0.03）的发生率：虽然 PAD（尤其是 IDP）降低了插管成功率，但 2015 年后，PAD 不再被视为插管的重大障碍。PAD增加了ERCP术后胰腺炎和出血的发生率。

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来源期刊

Journal of Digestive Diseases 医学-胃肠肝病学

CiteScore

5.40

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Digestive Diseases is the official English-language journal of the Chinese Society of Gastroenterology. The journal is published twelve times per year and includes peer-reviewed original papers, review articles and commentaries concerned with research relating to the esophagus, stomach, small intestine, colon, liver, biliary tract and pancreas.