Copyright
©The Author(s) 2020.
World J Gastroenterol. May 21, 2020; 26(19): 2403-2415
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2403
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2403
Table 1 Baseline clinical characteristics of the periampullary diverticulum and non- periampullary diverticulum groups
Non-PAD group (n = 2597) | PAD group (n = 967) | P value | |
Age, mean ± SD | 58 ± 16 | 65 ± 13 | < 0.001 |
Sex, n (%) | 0.004 | ||
Male | 1248 (48.1) | 517 (53.5) | |
Female | 1349 (51.9) | 450 (46.5) | |
History of cholecystectomy | 909 (35.0) | 356 (36.8) | 0.32 |
Gallbladder stones | 1001 (38.5) | 369 (38.2) | 0.83 |
Indications, n (%) | |||
Common bile duct stones | 1846 (71.1) | 823 (85.1) | < 0.001 |
Acute cholangitis | 291 (11.2) | 171 (17.7) | < 0.001 |
Malignant biliary stricture | 359 (13.8) | 50 (5.2) | < 0.001 |
Benign biliary stricture | 101 (3.9) | 33 (3.4) | 0.51 |
Acute pancreatitis | 248 (9.6) | 54 (5.6) | < 0.001 |
Pancreatic duct stones | 18 (0.7) | 4 (0.4) | 0.35 |
Comorbidity, n (%) | |||
Hypertension | 536 (20.6) | 239 (24.7) | 0.009 |
Diabetes | 212 (8.2) | 100 (10.3) | 0.04 |
Coronary disease | 67 (2.6) | 29 (3.0) | 0.49 |
Virus hepatitis | 140 (5.4) | 31 (3.2) | 0.007 |
Table 2 Baseline clinical characteristics of different types of periampullary diverticulum patients in the three classification systems
Lobo classification, 1998 | Boix classification, 2006 | Li-Tanaka classification, 2012 | |||||||
IDP | JPD | I | II | III | I | II | III | IV | |
Total | 65 | 902 | 306 | 556 | 105 | 65 | 655 | 105 | 142 |
Age, mean ± SD | 65 ± 11 | 65 ± 14 | 64 ± 13 | 65 ± 13 | 65 ± 15 | 65 ± 11 | 64 ± 14 | 65 ± 15 | 66 ± 12 |
Sex, n (%) | |||||||||
Male | 32 (49.2) | 485 (53.8) | 167 (54.6) | 293 (52.7) | 57 (54.3) | 32 (49.2) | 358 (54.7) | 57 (54.3) | 70 (49.3) |
Female | 33 (50.8) | 417 (46.2) | 139 (45.4) | 263 (47.3) | 48 (45.7) | 33 (50.8) | 297 (45.3) | 48 (45.7) | 72 (50.7) |
History of cholecystectomy | 15 (23.1) | 341 (37.8)a | 111 (36.3) | 221 (39.8) | 24 (22.9)a | 15 (23.1) | 263 (40.2) | 24 (22.9) | 54 (38.0)a |
Gallbladder stones | 28 (43.1) | 341 (37.8) | 117 (38.2) | 215 (38.7) | 37 (35.2) | 28 (43.1) | 249 (38.0) | 37 (35.2) | 55 (38.7) |
Indications, n (%) | |||||||||
Common bile duct stones | 53 (81.5) | 770 (85.4) | 265 (86.6) | 471 (84.7) | 87 (82.9) | 53 (81.5) | 561 (85.7) | 87 (82.9) | 122 (85.9) |
Acute cholangitis | 11 (16.9) | 160 (17.7) | 61 (19.9) | 96 (17.3) | 14 (13.3) | 11 (16.9) | 119 (18.2) | 14 (13.3) | 27 (19.0) |
Malignant biliary stricture | 2 (3.1) | 48 (5.3) | 13 (4.3) | 28 (5.0) | 9 (8.6) | 2 (3.1) | 30 (4.6) | 9 (8.6) | 9 (6.3) |
Benign biliary stricture | 1 (1.5) | 32 (3.6) | 8 (2.6) | 22 (4.0) | 3 (2.9) | 1 (1.5) | 26 (4.0) | 3 (2.9) | 3 (2.1) |
Acute pancreatitis | 5 (7.7) | 49 (5.4) | 25 (8.2) | 26 (4.7) | 3 (2.9)a | 5 (7.7) | 42 (6.4) | 3 (2.9) | 4 (2.8) |
Pancreatic duct stones | 0 | 4 (0.4) | 2 (0.7) | 2 (0.4) | 0 | 0 | 4 (0.6) | 0 | 0 |
Comorbidity, n (%) | |||||||||
Hypertension | 19 (29.2) | 220 (24.4) | 77 (25.2) | 134 (24.1) | 28 (26.7) | 19 (29.2) | 159 (24.3) | 28 (26.7) | 33 (23.2) |
Diabetes | 11 (16.9) | 89 (9.9) | 34 (11.1) | 54 (9.7) | 12 (11.4) | 11 (16.9) | 66 (10.1) | 12 (11.4) | 11 (7.8) |
Coronary disease | 5 (7.7) | 24 (2.7)a | 10 (3.3) | 18 (3.2) | 1 (1.0) | 5 (7.7) | 16 (2.4) | 1 (1.0) | 7 (4.9)a |
Virus hepatitis | 2 (3.1) | 29 (3.2) | 9 (2.9) | 17 (3.1) | 5 (4.8) | 2 (3.1) | 17 (2.6) | 5 (4.8) | 7 (4.9) |
Table 3 Diagnosis, procedures, and post-procedure complications for different types of periampullary diverticulum in three classification systems
Lobo classification, 1998 | Boix classification, 2006 | Li-Tanaka classification, 2012 | ||||||||||
IDP | JPD | P value | I | II | III | P value | I | II | III | IV | P value | |
Total | 65 (6.7) | 902 (93.3) | 306 (31.6) | 556 (57.5) | 105 (10.9) | 65 (6.7) | 655 (67.7) | 105 (10.9) | 142 (14.7) | |||
Diameter of CBD (mm) | 14 ± 4 | 14 ± 5 | 0.33 | 14 ± 5 | 15 ± 5 | 14 ± 6 | 0.37 | 14 ± 4 | 14 ± 5 | 14 ± 6 | 15 ± 5 | 0.56 |
Max. size of PAD (mm) | 19 ± 8 | 13 ± 7 | < 0.001 | 15 ± 8 | 13 ± 7 | 11 ± 7 | < 0.001 | 19 ± 8 | 13 ± 7 | 11 ± 7 | 14 ± 9 | < 0.001 |
≤ 10 | 11 (16.9) | 531 (58.9) | 146 (47.7) | 325 (58.5) | 71 (67.6) | 11 (16.9) | 384 (58.6) | 71 (67.6) | 76 (53.5) | |||
10-20 | 38 (58.5) | 287 (31.8) | 118 (38.6) | 182 (32.7) | 25 (23.8) | 38 (58.5) | 217 (33.1) | 25 (23.8) | 45 (31.7) | |||
> 20 | 16 (24.6) | 84 (9.3) | 42 (13.7) | 49 (8.8) | 9 (8.6) | 16 (24.6) | 54 (8.2) | 9 (8.6) | 21 (14.8) | |||
CBD stones | 51 (86.4) | 765 (85.6) | 0.85 | 262 (87.9) | 470 (85.0) | 84 (82.4) | 0.31 | 51 (86.4) | 559 (85.9) | 84 (82.4) | 122 (86.5) | 0.79 |
Max diameter (mm) | 13 ± 5 | 12 ± 7 | 0.23 | 12 ± 6 | 13 ± 7 | 12 ± 6 | 0.26 | 13 ± 5 | 12 ± 6 | 12 ± 6 | 13 ± 8 | 0.58 |
Multiple stone | 19 (37.3) | 353 (46.1) | 0.22 | 115 (43.9) | 224 (47.7) | 33 (39.3) | 0.29 | 19 (37.3) | 258 (46.2) | 33 (39.3) | 62 (50.8) | 0.24 |
Difficult stone removal | 16 (31.4) | 273 (35.7) | 0.53 | 96 (36.6) | 159 (33.8) | 34 (40.5) | 0.44 | 16 (31.4) | 195 (34.9) | 34 (40.5) | 44 (36.1) | 0.71 |
Mechanical lithotripsy | 4 (6.2) | 35 (3.9) | 0.33 | 21 (6.9) | 16 (2.9) | 2 (1.9) | 0.008 | 4 (6.2) | 31 (4.7) | 2 (1.9) | 2 (1.4) | 0.13 |
Retained stones | 3 (5.9) | 59 (7.7) | 0.79 | 20 (7.6) | 34 (7.2) | 8 (9.5) | 0.77 | 3 (5.9) | 38 (6.8) | 8 (9.5) | 13 (10.7) | 0.42 |
Guide wire in PD | 6 (9.2) | 86 (9.5) | 0.94 | 30 (9.8) | 48 (8.6) | 14 (13.3) | 0.32 | 6 (9.2) | 66 (10.1) | 14 (13.3) | 6 (4.2) | 0.08 |
ERPD | 1 (1.5) | 45 (5.0) | 0.36 | 11 (3.6) | 31 (5.6) | 4 (3.8) | 0.38 | 1 (1.5) | 36 (5.5) | 4 (3.8) | 5 (3.5) | 0.50 |
Operative time (min) | 44 ± 21 | 41 ± 18 | 0.35 | 41 ± 18 | 41 ± 17 | 43 ± 21 | 0.81 | 44 ± 21 | 41 ± 17 | 43 ± 21 | 39 ± 17 | 0.48 |
Difficult cannulation | 15 (23.1) | 93 (10.3) | 0.002 | 38 (12.4) | 57 (10.3) | 13 (12.4) | 0.57 | 15 (23.1) | 68 (10.4) | 13 (12.4) | 12 (8.5) | 0.01 |
Successful cannulation | 59 (90.8) | 894 (99.1) | < 0.001 | 298 (97.4) | 553 (99.5)a | 102 (97.1) | 0.02 | 59 (90.8) | 651 (99.4)b | 102 (97.1) | 141 (99.3)b | < 0.001 |
Adverse events | 8 (12.3) | 79 (8.8) | 0.33 | 26 (8.5) | 48 (8.6) | 13 (12.4) | 0.44 | 8 (12.3) | 57 (8.7) | 13 (12.4) | 9 (6.3) | 0.30 |
Post-ERCP pancreatitis | 5 (7.7) | 53 (5.9) | 0.58 | 19 (6.2) | 29 (5.2) | 10 (9.5) | 0.23 | 5 (7.7) | 38 (5.8) | 10 (9.5) | 5 (3.5) | 0.24 |
Acute cholangitis | 2 (3.1) | 25 (2.8) | 0.70 | 6 (2.0) | 18 (3.2) | 3 (2.9) | 0.55 | 2 (3.1) | 18 (2.8) | 3 (2.9) | 4 (2.8) | 0.98 |
Perforation | 1 (1.5) | 1 (0.1) | 0.13 | 1 (0.3) | 1 (0.2) | 0 (0.0) | 1.00 | 1 (1.5) | 1 (0.2) | 0 (0.0) | 0 (0.0) | 0.20 |
Table 4 Difficult cannulation for different types of periampullary diverticulum in the three classification groups compared with the non- periampullary diverticulum group
Variable | n/N (%) | Difficult cannulation | |
OR (95%CI) | P value | ||
Total | |||
Non-PAD | 317/2597 (12.2) | Ref | |
PAD | 108/967 (11.2) | 0.86 (0.68-1.09) | 0.21 |
Lobo classification | |||
Non-PAD | 317/2597 (12.2) | Ref | |
IDP | 15/65 (23.1) | 2.04 (1.13-3.68) | 0.006 |
JPD | 93/902 (10.3) | 0.79 (0.61-1.01) | 0.001 |
Boix classification | |||
Non-PAD | 317/2597 (12.2) | Ref | |
I | 38/306 (12.4) | 0.98 (0.68-1.40) | 0.73 |
II | 57/556 (10.3) | 0.78 (0.58-1.05) | 0.21 |
III | 13/105 (12.4) | 0.97 (0.53-1.75) | 0.85 |
Li-Tanaka classification | |||
Non-PAD | 317/2597 (12.2) | Ref | |
I | 15/65 (23.1) | 2.04 (1.13-3.68) | 0.004 |
II | 68/655 (10.4) | 0.80 (0.60-1.06) | 0.13 |
III | 13/105 (12.4) | 0.97 (0.53-1.75) | 0.91 |
IV | 12/142 (8.5) | 0.62 (0.34-1.13) | 0.06 |
Table 5 Successful cannulation for different types of periampullary diverticulum in the three classification groups compared with the non- periampullary diverticulum group
Variable | n/N (%) | Successful cannulation | |
OR (95%CI) | P value | ||
Total | |||
Non-PAD | 2531/2597 (97.5) | Ref | |
PAD | 953/967 (98.6) | 1.87 (1.04-3.37) | 0.037 |
Lobo classification | |||
Non-PAD | 2531/2597 (97.5) | Ref | |
IDP | 59/65 (90.8) | 0.27 (0.11-0.66) | < 0.001 |
JPD | 894/902 (99.1) | 3.07 (1.46-6.46) | < 0.001 |
Boix classification | |||
Non-PAD | 2531/2597 (97.5) | Ref | |
I | 298/306 (97.4) | 1.02 (0.48-2.15) | 0.27 |
II | 553/556 (99.5) | 5.09 (1.59-16.30) | 0.009 |
III | 102/105 (97.1) | 0.94 (0.29-3.04) | 0.33 |
Li-Tanaka classification | |||
Non-PAD | 2531/2597 (97.5) | Ref | |
I | 59/65 (90.8) | 0.27 (0.11-0.66) | < 0.001 |
II | 651/655 (99.4) | 4.44 (1.61-12.29) | 0.01 |
III | 102/105 (97.1) | 0.94 (0.29-3.04) | 0.49 |
IV | 141/142 (99.3) | 3.97 (0.55-28.95) | 0.19 |
- Citation: Yue P, Zhu KX, Wang HP, Meng WB, Liu JK, Zhang L, Zhu XL, Zhang H, Miao L, Wang ZF, Zhou WC, Suzuki A, Tanaka K, Li X. Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation. World J Gastroenterol 2020; 26(19): 2403-2415
- URL: https://www.wjgnet.com/1007-9327/full/v26/i19/2403.htm
- DOI: https://dx.doi.org/10.3748/wjg.v26.i19.2403