Shu J, Liao YS, Zhang YJ, Zhou WL, Zhang H. Impact of periampullary diverticulum on the incidence of post-endoscopic retrograde cholangiography pancreatitis. World J Gastrointest Endosc 2025; 17(11): 111243 [PMID: 41256294 DOI: 10.4253/wjge.v17.i11.111243]
Corresponding Author of This Article
Heng Zhang, MD, PhD, Chief Physician, Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Jiangan District, Wuhan 430014, Hubei Province, China. 15802796240@163.com
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Gastroenterology & Hepatology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 16, 2025 (publication date) through Dec 13, 2025
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World Journal of Gastrointestinal Endoscopy
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Shu J, Liao YS, Zhang YJ, Zhou WL, Zhang H. Impact of periampullary diverticulum on the incidence of post-endoscopic retrograde cholangiography pancreatitis. World J Gastrointest Endosc 2025; 17(11): 111243 [PMID: 41256294 DOI: 10.4253/wjge.v17.i11.111243]
World J Gastrointest Endosc. Nov 16, 2025; 17(11): 111243 Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.111243
Impact of periampullary diverticulum on the incidence of post-endoscopic retrograde cholangiography pancreatitis
Juan Shu, Yu-Sheng Liao, Yuan-Jie Zhang, Wei-Lai Zhou, Heng Zhang
Juan Shu, Yu-Sheng Liao, Yuan-Jie Zhang, Wei-Lai Zhou, Heng Zhang, Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Co-first authors: Juan Shu and Yu-Sheng Liao.
Author contributions: Shu J and Liao YS performed the research and wrote the manuscript; Zhang YJ performed the research and collected the data; Zhou WL performed the research; Zhang H designed the experiments and revised the manuscript. Shu J and Liao YS are co-first authors of this article, having contributed equally to the research and manuscript preparation.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Central Hospital of Wuhan (Approval No. WHZXKYL2025-135).
Informed consent statement: Informed consent was waived due to the retrospective nature of this research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Dataset available from the corresponding author. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Heng Zhang, MD, PhD, Chief Physician, Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Jiangan District, Wuhan 430014, Hubei Province, China. 15802796240@163.com
Received: June 26, 2025 Revised: August 18, 2025 Accepted: September 23, 2025 Published online: November 16, 2025 Processing time: 141 Days and 16 Hours
Abstract
BACKGROUND
Periampullary diverticulum (PAD) is a common anatomical variant, but its association with post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains controversial. While PAD may alter ampullary anatomy, increasing technical difficulty during ERCP, existing studies report inconsistent findings on its role in PEP pathogenesis. We hypothesize that PAD presence, particularly type B, shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.
AIM
To examine the association between PAD (including subtypes A/B) and PEP incidence after ERCP for choledocholithiasis.
METHODS
We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025. Participants were stratified into PAD (n = 183; subtype A = 125, subtype B = 58) and non-PAD (n = 432) groups. The primary outcome was PEP incidence. Multivariable logistic regression adjusted for age, sex, hypertension, diabetes, gallbladder surgery, and guidewire insertion. Statistical significance was set at P < 0.05 (two-tailed).
RESULTS
PAD prevalence was 29.8% (183/615). PEP occurrence was more frequent in PAD patients [15.3% (28/183)] than in non-PAD patients [4.2% (18/432)], odds ratio (OR) = 3.86, 95% confidence interval: 2.03-7.35, P < 0.001. Type B PAD showed a stronger association with PEP than type A (OR = 14.16, 95% confidence interval: 5.84-34.34, P < 0.001). Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients (adjusted OR = 5.02, P < 0.05). Hypertension also demonstrated an association with PEP in the PAD subgroup (P = 0.012).
CONCLUSION
PAD, particularly type B, is independently associated with PEP after ERCP. Patients with these features, especially those with hypertension or pancreatic duct instrumentation, may benefit from enhanced monitoring and prophylaxis.
Core Tip: This study demonstrates that periampullary diverticulum (PAD), particularly type B, shows a significant association with post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The findings suggest that PAD subtype evaluation may help identify patients with higher likelihood of PEP development. The results indicate potential clinical value of enhanced postoperative monitoring for patients with specific diverticular characteristics and optimization of endoscopic retrograde cholangiopancreatography techniques. These observations contribute to refining PEP prevention strategies and support consideration of individualized procedural approaches.
