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Silman C, Matsumoto S, Yamada Y, Sena Y, Hongo N, Takaji R, Kiyonaga M, Ogawa R, Okamoto K, Murakami K. Evaluation of juxtapapillary duodenal diverticula using multiplanar reformation in MDCT: correlation with ERCP findings. Jpn J Radiol 2020; 38:968-972. [PMID: 32488500 DOI: 10.1007/s11604-020-00995-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the ability of multidetector computed tomography (MPR-MDCT) to identify and classify the juxtapapillary duodenal diverticulum (JPDD), with ERCP findings as the gold standard. METHODS We retrospectively reviewed all ERCP examinations (n: 455) performed between January 2010 to December 2018 and selected 105 patients with JPDD as the inclusion criteria. Of those, 28 patients were excluded because of advanced pancreatic carcinoma, incomplete MDCT examinations and biliary catheter insertion. Finally, MDCT examinations of 77 patients with JPDD were assessed for the presence and type of JPDD. RESULTS MPR-MDCT was able to identify 71 (92.2%) JPDD in 77 cases with 88.9% accuracy, 83.3% sensitivity, and 91.6% specificity in classifying the type of JPDD. MPR-MDCT performed best in determining type 1 JPDD, with accuracy of 95.4% compared with type 2 (83.3%) and type 3 (87.8%). There was no significant difference between age, gender, incidence of biliary stones and pancreatitis between each type of JPDD. No correlation of sizes with types of JPDD was found. CONCLUSIONS MPR-MDCT can accurately identify and classify JPDD. This information will be useful in determining the difficulty of ERCP.
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Affiliation(s)
- Christopher Silman
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Shunro Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yankel Sena
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Ryo Ogawa
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhisa Okamoto
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
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Yue P, Zhu KX, Wang HP, Meng WB, Liu JK, Zhang L, Zhu XL, Zhang H, Miao L, Wang ZF, Zhou WC, Suzuki A, Tanaka K, Li X. Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation. World J Gastroenterol 2020; 26:2403-2415. [PMID: 32476801 PMCID: PMC7243649 DOI: 10.3748/wjg.v26.i19.2403] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Ping Yue
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical School of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ke-Xiang Zhu
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hai-Ping Wang
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Bo Meng
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, 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
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Liang Zhu
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hui Zhang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Long Miao
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Zheng-Feng Wang
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Ce Zhou
- Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Azumi Suzuki
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 602-8026, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 602-8026, Japan
| | - 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
- Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical School of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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