Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation
Ping Yue, Ke-Xiang Zhu, Hai-Ping Wang, Wen-Bo Meng, Jian-Kang Liu, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Azumi Suzuki, Kiyohito Tanaka, Xun Li
Ping Yue, Wen-Bo Meng, Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Ping Yue, Ke-Xiang Zhu, Wen-Bo Meng, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Xun Li, Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Ping Yue, Ke-Xiang Zhu, Wen-Bo Meng, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Xun Li, Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
Ping Yue, Xun Li, The First Clinical Medical School of Lanzhou University, Lanzhou 730000, Gansu Province, China
Ke-Xiang Zhu, Hai-Ping Wang, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Jian-Kang Liu, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02451, United States
Lei Zhang, Xiao-Liang Zhu, Xun Li, The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Azumi Suzuki, Kiyohito Tanaka, Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 602-8026, Japan
Author contributions: Yue P, Meng WB, Suzuki A, Tanaka K, and Li X designed the research protocol; Yue P, Meng WB, Wang HP, Zhang L, Zhu KX, Zhu XL, Zhang H, Miao L, Wang ZF, Zhou WC, and Li X were responsible for patient enrollment and data acquisition; Yue P, Wang HP, and Meng WB contributed to data analysis and interpretation; Yue P, Zhu KX, and Meng WB wrote the paper; Yue P, Meng WB, and Li X contributed to critical revision of the manuscript for important intellectual content; Wang HP and Liu JK contributed to statistical analysis; Li X contributed to final approval of the article.
Supported by the National Natural Science Foundation of China, NO. 31570509.
Institutional review board statement: The clinical research was approved by the Ethics Committee of the First Hospital of Lanzhou University.
Informed consent statement: Written informed consent was obtained from the patients for using their data in scientific studies while protecting their anonymity before the procedure.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xun Li, MD, PhD, Professor, President, The Fifth Department of General Surgery, The First Hospital of Lanzhou University, No. 1, Donggang West Road, Lanzhou 730000, Gansu Province, China. drlixun@163.com
Received: February 26, 2020
Peer-review started: February 26, 2020
First decision: April 2, 2020
Revised: April 9, 2020
Accepted: May 1, 2020
Article in press: May 1, 2020
Published online: May 21, 2020
BACKGROUND
Different types of periampullary diverticulum (PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation, but the clinical significance of the two current PAD classifications for cannulation is limited.
AIM
To verify the clinical value of our newly proposed PAD classification.
METHODS
A new PAD classification (Li-Tanaka classification) was proposed at our center. All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.
RESULTS
A total of 3564 patients with native papillae were enrolled, including 967 (27.13%) PAD patients and 2597 (72.87%) non-PAD patients. In the Li-Tanaka classification, type I PAD patients exhibited the highest difficult cannulation rate (23.1%, P = 0.01), and type II and IV patients had the highest cannulation success rates (99.4% in type II and 99.3% in type IV, P < 0.001). In a multivariable-adjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio (OR) = 1.87, 95% confidence interval (CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group, the difficulty of cannulation in the type I PAD group according to the Li-Tanaka classification was greater (OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower (OR = 0.27, 95%CI: 0.11-0.66, P < 0.001), while it was higher in the type II PAD group (OR = 4.44, 95%CI: 1.61-12.29, P < 0.01).
CONCLUSION
Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.
Core tip: Unlike previous studies conducted more than a decade ago, most current studies no longer suggest that periampullary diverticulum (PAD) significantly increases the difficulty of cannulation. However, we found that different clinical types of PAD may affect the difficulty and even success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation. Furthermore, existing PAD classifications have limited clinical guidance value. We proposed a new PAD classification method (Li-Tanaka classification) in 2012 based on the number of PADs and their anatomical relationship with the major papilla, and we conducted a retrospective study to evaluate the clinical value of the Li-Tanaka PAD classification for ERCP cannulation. Our study showed that the Li-Tanaka classification has good clinical significance for ERCP cannulation.
