PERIAMPULLARY DIVERTICULA - CONSEQUENCES OF FAILED ERCP

Periampullary diverticula (PAD) are associated with biliary disease an d contribute to failure of endoscopic retrograde cholangiopancreatogra phy (ERCP), especially in elderly patients. The presence of PAD and ca uses of failure to cannulate the ampulla were noted in 1211 consecutiv e patients undergoing ERCP. Case notes of 100 consecutive patients wit h PAD were reviewed retrospectively. Overall prevalence of PAD was 9%. Prevalence was higher in patients greater than or equal to 75 years w hen compared with those <75 years (19.2% us 4.8%, P<0.0001). Ampullary cannulation was successful in 62.4% of patients with PAD and 92.7% wi thout PAD (P<0.0001). Success rates were lower in patients with intrad iverticular papillae than in those with juxtapapillary diverticula (38 .1% vs 77.6%; P<0.0001). Of 19 patients with PAD who did not have any imaging other than ultrasound, 16 were asymptomatic over a median foll ow-up of 20 months. Biliary surgery was performed on 35 patients, with no major complication. PAD are a major cause of failed ERCP. Failure rates are higher in patients with intradiverticular papillae than juxt apapillary diverticula. Though a large proportion of patients not imag ed remain asymptomatic on follow-up, it is difficult to predict which patients may form this group. Surgery, when indicated, is safe and eff ective in elderly patients in whom ERCP has failed.