The Effect of Periampullary Diverticulum on Technical Success Rate of Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis

Abstract

Background: Currently, endoscopic retrograde cholangiopancreatography (ERCP) is one of the most practical measures in the diagnosis and management of various pancreatobiliary diseases. Difficult cannulation which contributes to developing side effects of ERCP, is influenced by many factors, one of which is anatomic variants such as periampullary diverticulum (PAD). The purpose of current systematic review study was the investigation of the effect of periampullary diverticulum on technical success rate of endoscopic cholangiopancreatography. The general conclusion would be presented based on statistical analysis. Methods: In the current study, MEDLINE, PubMed and EMBASE databases were searched in February 30th, 2012 using a sensitive search strategy to retrieve relevant studies in English language. The data met the inclusion criteria were selected for the study. Statistical analysis was carried out using CMA.2 software. Findings: Eleven articles with a total sample size of 12243 and an average consensus of 88% among researchers entered into the survey and all of the necessary data were obtained. The results of statistical analysis indicated low success rate of cannulatoin in patients with PAD in comparison with those without it (OR = 0.502؛ CI 95% (0.262-0.961); P < 0.038). Conclusion: Performing ERCP cannulation in patients with and without PAD carries a lower success rate respectively. Nevertheless, the recent studies which employ new methodology does not demonstrate this low success rate.

Keywords

• Cholangiopancreatography
• Endoscopic retrograde
• Diverticulum
• Meta-analysis