CONVENTIONAL ENDOSCOPIC SPHINTEROTOMY VS. TINY ENDOSCOPIC SPHINTEROTOMY FOLLOWED BY BALLOON DILATION AND THE RISK OF POST-CPRE HEMORRHAGE IN PATIENTS WITH PERIAMPULAR DIVERTICULUM

Aims

• Determine the rate of post-ERCP hemorrhage in patients with periampular diverticulum (papilla located inside or on the margin of a duodenal diverticulum).

• Determine the efficiency and safety analysis.

Methods Descriptive and retrospective study. 1,333 ERCP procedures, performed consecutively, between January 2014 and April 201. It is a single-center study in a tertiary care center. All cases with periampular diverticulum and naïve papilla were included. Conventional endoscopic sphincterotomy is defined to which the size of the papilla cut is conditioned according to the size of the lithiasis facilitating its extraction. As for another group, a millimeter cut was performed in order to mark the direction in which the fibers will break when the papillary balloon dilation is performed [up to 15 mm].

Results In 235 cases (17.6%) the presence of periampular diverticulum was identified. Predominantly males (60.7%). Age: Mean 78.2 years (Range: 29-96). The main indication was choledocholithiasis (78.7%). One group performed conventional sphinterotomy (148 cases) and other group performed a tiny sphinterotomy followed by balloon dilation (52 cases). A higher rate of post-ERCP hemorrhage was identified in the conventional sphinterotomy group compared to tiny sphinterotomy followed by balloon dilation (5.4% vs. 1.9%, p=0.010). We did not find significant differences in terms of technique success (87.5% vs. 100%, p = NS) nor of post-ERCP pancreatitis (6.8% VS. 7.7%, p=0.017).

Conclusions Tiny sphinterotomy followed by balloon dilation seems to be a safer procedure with similar effectiveness in patients with periampular diverticulum.