Table 3.
Diagnosis, procedures, and post-procedure complications for different types of periampullary diverticulum in three classification systems
|
Lobo classification, 1998 |
Boix classification, 2006 |
Li-Tanaka classification, 2012 |
||||||||||
| IDP | JPD | P value | I | II | III | P value | I | II | III | IV | P value | |
| Total | 65 (6.7) | 902 (93.3) | 306 (31.6) | 556 (57.5) | 105 (10.9) | 65 (6.7) | 655 (67.7) | 105 (10.9) | 142 (14.7) | |||
| Diameter of CBD (mm) | 14 ± 4 | 14 ± 5 | 0.33 | 14 ± 5 | 15 ± 5 | 14 ± 6 | 0.37 | 14 ± 4 | 14 ± 5 | 14 ± 6 | 15 ± 5 | 0.56 |
| Max. size of PAD (mm) | 19 ± 8 | 13 ± 7 | < 0.001 | 15 ± 8 | 13 ± 7 | 11 ± 7 | < 0.001 | 19 ± 8 | 13 ± 7 | 11 ± 7 | 14 ± 9 | < 0.001 |
| ≤ 10 | 11 (16.9) | 531 (58.9) | 146 (47.7) | 325 (58.5) | 71 (67.6) | 11 (16.9) | 384 (58.6) | 71 (67.6) | 76 (53.5) | |||
| 10-20 | 38 (58.5) | 287 (31.8) | 118 (38.6) | 182 (32.7) | 25 (23.8) | 38 (58.5) | 217 (33.1) | 25 (23.8) | 45 (31.7) | |||
| > 20 | 16 (24.6) | 84 (9.3) | 42 (13.7) | 49 (8.8) | 9 (8.6) | 16 (24.6) | 54 (8.2) | 9 (8.6) | 21 (14.8) | |||
| CBD stones | 51 (86.4) | 765 (85.6) | 0.85 | 262 (87.9) | 470 (85.0) | 84 (82.4) | 0.31 | 51 (86.4) | 559 (85.9) | 84 (82.4) | 122 (86.5) | 0.79 |
| Max diameter (mm) | 13 ± 5 | 12 ± 7 | 0.23 | 12 ± 6 | 13 ± 7 | 12 ± 6 | 0.26 | 13 ± 5 | 12 ± 6 | 12 ± 6 | 13 ± 8 | 0.58 |
| Multiple stone | 19 (37.3) | 353 (46.1) | 0.22 | 115 (43.9) | 224 (47.7) | 33 (39.3) | 0.29 | 19 (37.3) | 258 (46.2) | 33 (39.3) | 62 (50.8) | 0.24 |
| Difficult stone removal | 16 (31.4) | 273 (35.7) | 0.53 | 96 (36.6) | 159 (33.8) | 34 (40.5) | 0.44 | 16 (31.4) | 195 (34.9) | 34 (40.5) | 44 (36.1) | 0.71 |
| Mechanical lithotripsy | 4 (6.2) | 35 (3.9) | 0.33 | 21 (6.9) | 16 (2.9) | 2 (1.9) | 0.008 | 4 (6.2) | 31 (4.7) | 2 (1.9) | 2 (1.4) | 0.13 |
| Retained stones | 3 (5.9) | 59 (7.7) | 0.79 | 20 (7.6) | 34 (7.2) | 8 (9.5) | 0.77 | 3 (5.9) | 38 (6.8) | 8 (9.5) | 13 (10.7) | 0.42 |
| Guide wire in PD | 6 (9.2) | 86 (9.5) | 0.94 | 30 (9.8) | 48 (8.6) | 14 (13.3) | 0.32 | 6 (9.2) | 66 (10.1) | 14 (13.3) | 6 (4.2) | 0.08 |
| ERPD | 1 (1.5) | 45 (5.0) | 0.36 | 11 (3.6) | 31 (5.6) | 4 (3.8) | 0.38 | 1 (1.5) | 36 (5.5) | 4 (3.8) | 5 (3.5) | 0.50 |
| Operative time (min) | 44 ± 21 | 41 ± 18 | 0.35 | 41 ± 18 | 41 ± 17 | 43 ± 21 | 0.81 | 44 ± 21 | 41 ± 17 | 43 ± 21 | 39 ± 17 | 0.48 |
| Difficult cannulation | 15 (23.1) | 93 (10.3) | 0.002 | 38 (12.4) | 57 (10.3) | 13 (12.4) | 0.57 | 15 (23.1) | 68 (10.4) | 13 (12.4) | 12 (8.5) | 0.01 |
| Successful cannulation | 59 (90.8) | 894 (99.1) | < 0.001 | 298 (97.4) | 553 (99.5)a | 102 (97.1) | 0.02 | 59 (90.8) | 651 (99.4)b | 102 (97.1) | 141 (99.3)b | < 0.001 |
| Adverse events | 8 (12.3) | 79 (8.8) | 0.33 | 26 (8.5) | 48 (8.6) | 13 (12.4) | 0.44 | 8 (12.3) | 57 (8.7) | 13 (12.4) | 9 (6.3) | 0.30 |
| Post-ERCP pancreatitis | 5 (7.7) | 53 (5.9) | 0.58 | 19 (6.2) | 29 (5.2) | 10 (9.5) | 0.23 | 5 (7.7) | 38 (5.8) | 10 (9.5) | 5 (3.5) | 0.24 |
| Acute cholangitis | 2 (3.1) | 25 (2.8) | 0.70 | 6 (2.0) | 18 (3.2) | 3 (2.9) | 0.55 | 2 (3.1) | 18 (2.8) | 3 (2.9) | 4 (2.8) | 0.98 |
| Perforation | 1 (1.5) | 1 (0.1) | 0.13 | 1 (0.3) | 1 (0.2) | 0 (0.0) | 1.00 | 1 (1.5) | 1 (0.2) | 0 (0.0) | 0 (0.0) | 0.20 |
For Boix classification, P = 0.017 with Bonferroni adjustment. For Li-Tanaka classification, P = 0.008 with Bonferroni adjustment. Successful cannulation: Boix: Type II vs type I,
a
P < 0.05; Li-Tanaka classification: Type II vs type I,
b
P < 0.01, type IV vs type I, bP < 0.01. CBD: Common bile duct; PAD: Periampullary diverticulum; ERCP: Endoscopic retrograde cho-langiopancreatography; ERPD: Endoscopic retrograde pancreatic drainage; PD: Pancreatic duct.