Impact of periampullary diverticulum on the incidence of post-endoscopic retrograde cholangiography pancreatitis

Table 1 Baseline characteristics of the study participants, mean ± SD/n (%)

Variable	Total (n = 615)	Absence of diverticulum (n = 432)	Presence of diverticulum (n = 183)	Statistical value (t/χ2)	P value
Sex				1.298	0.255
Male	311 (50.6)	212 (49.1)	99 (54.1)
Female	304 (49.4)	220 (50.9)	84 (45.9)
Age	63.8 ± 15.4	61.6 ± 15.9	69.0 ± 12.8	-6.082	< 0.001
Hypertension				0.942	0.332
No	341 (55.4)	245 (56.7)	96 (52.5)
Yes	274 (44.6)	187 (43.3)	87 (47.5)
Diabetes				0.576	0.448
No	518 (84.2)	367 (85.0)	151 (82.5)
Yes	97 (15.8)	65 (15.0)	32 (17.5)
Coronary heart disease				0.777	0.378
No	526 (85.5)	373 (86.3)	153 (83.6)
Yes	89 (14.5)	59 (13.7)	30 (16.4)
Hepatitis				0.766	0.382
No	573 (93.2)	405 (93.8)	168 (91.8)
Yes	42 (6.8)	27 (6.2)	15 (8.2)
History of cholecystectomy				0.999	0.317
No	486 (79.0)	346 (80.1)	140 (76.5)
Yes	129 (21.0)	86 (19.9)	43 (23.5)

Table 2 Univariate analysis of the risk factors associated with post-endoscopic retrograde cholangiopancreatography pancreatitis

Variable	OR (95%CI)	P value
Sex: Male vs female	1.39 (0.74-2.61)	0.313
Age (years)	1.01 (0.99-1.03)	0.451
PAD: Yes vs no	3.86 (2.03-7.35)	< 0.001
Guidewire insertion into the pancreatic duct: Yes vs no	4.17 (2.17-7.99)	< 0.001
Hypertension: Yes vs no	0.75 (0.39-1.42)	0.372
Diabetes mellitus: Yes vs no	0.71 (0.27-1.85)	0.483
Coronary heart disease: Yes vs no	0.99 (0.4-2.42)	0.979
Hepatitis: Yes vs no	0.32 (0.04-2.37)	0.263
History of cholecystectomy: Yes vs no	0.38 (0.13-1.08)	0.07
Postoperative hyperamylasemia: Yes vs no	0.09 (0.01-0.65)	0.017

PAD: Periampullary diverticulum; OR: Odds ratio; CI: Confidence interval.

Table 3 Multivariate Logistic regression analysis of periampullary diverticulum and post-endoscopic retrograde cholangiopancreatography pancreatitis incidence

Variable	Crude		Model 12		Model 23
	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
PAD
No	1.01		1.01		1.01
Yes	3.86 (2.03-7.35)	< 0.001	4.13 (2.1-8.11)	< 0.001	4.23 (2.06-8.69)	< 0.001
PAD type
Non-PAD	1.01		1.01		1.01
A-PAD	1.22 (0.47-3.17)	0.68	1.32 (0.5-3.49)	0.572	1.52 (0.56-4.17)	0.411
B-PAD	13.38 (6.39-28.03)	< 0.001	14.65 (6.63-32.33)	< 0.001	14.16 (5.84-34.34)	< 0.001
P value for trend		0.052		0.056		0.039

¹1.0 was used as the reference group, indicates the reference category.

²Model 1: Adjusted for age and sex.

³Model 2: Adjusted for model 1 + periampullary diverticulum, guidewire insertion into the pancreatic duct during endoscopic retrograde cholangiopancreatography, hypertension, diabetes mellitus, coronary heart disease, hepatitis, history of cholecystectomy, post- endoscopic retrograde cholangiopancreatography pancreatitis, Postoperative hyperamylasemia.

PAD: Periampullary diverticulum; A-PAD: Type A periampullary diverticulum; B-PAD: Type B periampullary diverticulum; OR: Odds ratio; CI: Confidence interval.

Table 4 Subgroup analyses of the association between periampullary diverticulum and incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis, n (%)

Subgroup	Total	Event	Crude OR (95%CI)	Crude P value	Adjusted OR (95%CI)	Adjusted P value	P value for interaction
Males							0.797
No	212	7 (3.3)	1.01		1.01
Yes	99	11 (11.1)	3.66 (1.37-9.75)	0.009	3.74 (1.38-10.1)	0.009
Females
No	220	10 (4.5)	1.01		1.01
Yes	84	14 (16.7)	4.2 (1.79-9.88)	0.001	4.49 (1.78-11.33)	0.002
Without hypertension							0.162
No	245	13 (5.3)	1.01		1.01
Yes	96	13 (13.5)	2.8 (1.25-6.27)	0.013	2.52 (1.07-5.92)	0.034
With hypertension
No	187	4 (2.1)	1.01		1.01
Yes	87	12 (13.8)	7.32 (2.29-23.42)	0.001	7.64 (2.36-24.71)	0.001
Without diabetes mellitus							0.398
No	367	16 (4.4)	1.01		1.01
Yes	151	21 (13.9)	3.54 (1.79-7)	< 0.001	3.46 (1.71-6.99)	0.001
With diabetes mellitus
No	65	1 (1.5)	1.01		1.01
Yes	32	4 (12.5)	9.14 (0.98-85.53)	0.052	11.54 (1.15-116.01)	0.038
Without coronary heart disease							0.91
No	373	15 (4)	1.01		1.01
Yes	153	21 (13.7)	3.8 (1.9-7.59)	< 0.001	3.71 (1.79-7.67)	< 0.001
With coronary heart disease
No	59	2 (3.4)	1.01		1.01
Yes	30	4 (13.3)	4.38 (0.75-25.48)	0.1	3.59 (0.6-21.49)	0.162
Without hepatitis							0.374
No	405	17 (4.2)	1.01		1.01
Yes	168	24 (14.3)	3.8 (1.99-7.29)	< 0.001	3.95 (2.01-7.75)	< 0.001
With hepatitis
No	27	0 (0)	1.01		1.01
Yes	15	1 (6.7)	02	*	7.82 (0.65-94.5)	0.105
With history of cholecystectomy							0.485
No	346	15 (4.3)	1.01		1.01
Yes	140	23 (16.4)	4.34 (2.19-8.59)	< 0.001	4.43 (2.17-9.04)	< 0.001
Without history of cholecystectomy
No	86	2 (2.3)	1.01		1.01
Yes	43	2 (4.7)	2.05 (0.28-15.07)	0.481	2.01 (0.27-14.96)	0.495
Guidewires enter the pancreatic duct							0.315
No	67	8 (11.9)	1.01		1.01
Yes	47	11 (23.4)	2.25 (0.83-6.13)	0.112	1.93 (0.66-5.67)	0.233
Guidewires did not enter the pancreatic duct
No	365	9 (2.5)	1.01		1.01
Yes	136	14 (10.3)	4.54 (1.92-10.75)	0.001	5.02 (2.06-12.26)	< 0.001
Without hyperamylasemia							0.419
No	355	17 (4.8)	1.01		1.01
Yes	136	24 (17.6)	4.26 (2.21-8.22)	< 0.001	4.27 (2.18-8.38)	< 0.001
With hyperamylasemia
No	77	0 (0)	1.01		1.01
Yes	47	1 (2.1)	02	02	5.91 (0.52-67.8)	0.158

¹1.0 was used as the reference group, indicates the reference category.

²Statistical value (the crude odds ratio, its 95% confidence interval, and the corresponding crude P value) could not be calculated due to the characteristics of the raw data.

OR: Odds ratio; CI: Confidence interval.