Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2403
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
Currently, periampullary diverticulum (PAD) is no longer considered an obstacle to the success of ERCP cannulation in many studies. Different types of PAD may differentially affect the difficulty and success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation; however, the clinical significance of the two existing PAD classifications for cannulation is limited.
In clinical practice, we found that the effect of PAD on ERCP cannulation was related to the characteristics of the diverticulum. A new PAD classification (Li-Tanaka classification) was proposed, and a retrospective study was conducted to evaluate its clinical guidance value for ERCP cannulation.
The objective of this study was to verify the clinical value of our newly proposed PAD classification.
A novel 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.
Unlike Lobo and Boix classifications, Li-Tanaka classification, which is based on the number of PADs and their anatomical relationship with the major papilla, showed different types of PAD with distinguishing difficulty and success rates of ERCP cannulation. In the Li-Tanaka classification, type I PAD patients exhibited the highest difficult cannulation rate, and types II and IV patients had the highest cannulation success rates. In a multivariable-adjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients. 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, and the success rate of cannulation was lower, while it was higher in the type II PAD group.
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.
Long-term effects of different types of PAD on biliary diseases after ERCP are worthy studying at the subsequent follow-up. What’s more, further prospective studies are needed to determine the clinical guidance value of PAD classification in ERCP cannulation and complications, and what appropriate techniques can be used for different types of PAD with difficult cannulation.