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Trial registered on ANZCTR
Registration number
ACTRN12613000415707
Ethics application status
Approved
Date submitted
3/04/2013
Date registered
15/04/2013
Date last updated
15/04/2013
Type of registration
Retrospectively registered
Titles & IDs
Public title
Intradiverticular ampulla of Vater: personal experience at endoscopic retrograde cholangiopancreatography (ERCP).
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Scientific title
In adult with biliary pathology, is the presence of intradiverticular ampulla of Vater, retrospectively compared with normal ampulla of Vater, is responsible for higher incidence of technical failure of endoscopic retrograde cholangiopancreatography (ERCP)?
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Secondary ID [1]
282240
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none
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
biliary pathology
288758
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anatomic abnormality
288759
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Condition category
Condition code
Oral and Gastrointestinal
289115
289115
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0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Retrospective evaluation of patients with biliary pathology related to intradiverticular ampulla of Vater visualized at endoscopic retrograde cholangiopancreatography (ERCP).
The aim of this study is to evaluate the success rate, difficult cannulation and complication rate between patients with and without intradiverticular ampulla of Vater, as well as to identify any independent factor that may influence the difficulty in cannulation. The duration of observation is 1 year.
All the procedures were performed by the same skilled team. All patients received a combination of midazolam and fentanyl, on escalating dosing according to the needs for conscious sedation. Supplemental oxygen was also given trans-nasally during the entire procedure.
The patients were only observed at the time of ERCP, the successive follow-up was only clinic and laboratoristic at 1, 6 and 12 months after ERCP.
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Intervention code [1]
286850
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Not applicable
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Comparator / control treatment
The aim of this study is to evaluate the success rate, difficult cannulation and complication rate between patients with and without IA, as well as to identify any independent factor that may influence the difficulty in cannulation. The duration of follow up in each patients is 1 year. The period of historical data collection is January 2008 - December 2012 (500 consecutive patients underwent endoscopic retrograde cholangiopancreatography; data were obtained from University Hospital of Palermo informatic database).
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Control group
Historical
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Outcomes
Primary outcome [1]
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Biliary cannulation was attempted by using a standard three-lumen sphincterotome. Cannulation was considered successful when the sphincterotome or the ERCP catheter was inserted deeply into the common bile duct and a cholangiogram was obtained. Difficult of deep cannulation was defined according to the Boix and coworkers classification.
Sphincterotomy was performed with an endo-cut mode.
All the data were registered in a database.
We considered primary outcome success rate of biliary deep cannulation.
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Assessment method [1]
289227
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Timepoint [1]
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During procedure, at the time of cannulation
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Secondary outcome [1]
302075
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Complication at ERCP: postoperative cholangitis, pancreatitis; duodenal perforation, ampullary bleeding.
All the complication were identified, registered and evaluated to solve in endoscopic room or in operatory theatre.
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Assessment method [1]
302075
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Timepoint [1]
302075
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During the procedure
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Eligibility
Key inclusion criteria
500 consecutive patients underwent endoscopic retrograde cholangiopancreatography: in the control group are the patients underwent endoscopic retrograde cholangiopancreatography with normal ampulla of Vater
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Minimum age
18
Years
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Maximum age
89
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Previous biliary surgery, previous biliary sphincterotomy
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Study design
Purpose
Natural history
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Duration
Cross-sectional
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Selection
Random sample
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Timing
Retrospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
7/01/2008
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Actual
7/01/2008
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Date of last participant enrolment
Anticipated
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Actual
20/12/2012
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
500
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
4968
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Italy
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State/province [1]
4968
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Sicily
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Funding & Sponsors
Funding source category [1]
287003
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Hospital
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Name [1]
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University of Palermo
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Address [1]
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Via Liborio Giuffre, 5
POSTAL CODE: 90127
Palermo, Sicily, Italy
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Country [1]
287003
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Italy
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Primary sponsor type
University
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Name
University of Palermo
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Address
Via Liborio Giuffre, 5
POSTAL CODE: 90127
Palermo, Sicily, Italy
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Country
Italy
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Secondary sponsor category [1]
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None
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Name [1]
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none
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Address [1]
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none
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Country [1]
285787
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Ethics approval
Ethics application status
Approved
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Summary
Brief summary
Introduction: Intradiverticular ampulla (IA) is found in 9% to 32% of patients undergoing endoscopic retrograde cholagiopancreatography (ERCP). Contradictory results have been reported in the literature with regard to the true impact of IA on the technical success and complication rate of ERCP. Objective: The aim of this study is to evaluate the success rate, difficult cannulation and complication rate between patients with and without IA, as well as to identify any independent factor that may influence the difficulty in cannulation. Design: A retrospective study. Setting: University Hospital of Palermo. Section of General and Thoracic Surgery. Division of Surgical Endoscopy. Patients: A total of 500 consecutive patients who underwent ERCP were divided into 2 groups according to the presence (group A, 81 patients) or absence (group B, 419 patients) of IA. Results: Successful cannulation was achieved in 100% of group A patients compared to 98% of group B patients (p = ns). There was a significant difference (p < 0.05) in the type of cannulation, that was routinary in group B while required guide-wire or special sphincterotome in group A (p < 0.05). Cholangitis (p < 0.05), microstone, stone recurrence (p < 0.05), normal cholangiogram (p < 0.005) and transient hyperamylasemia (p < 0.005) were more frequently observed among group A patients. There was no significant difference in complication rate between both the groups. Conclusions: IA becomes more frequent with ageing and is a risk factor for biliary stone disease. IA is also associated with post-ERCP transient hyperamylasemia and biliary stone recurrence. The finding of an IA at ERCP should not be considered a predictor for failed cannulation. In fact, it may indicate an easier cannulation attempt in selected cases, provided that the papilla can be found with confidence.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Girolamo Geraci
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Address
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University of Palermo
Section of General and Thoracic Surgery
Via Liborio Giuffre, 5
POSTAL CODE: 90127
Palermo, Sicily, Italy
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Country
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Italy
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Phone
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+39916552773
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Fax
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+39916552774
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Email
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[email protected]
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Contact person for public queries
Name
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Girolamo Geraci
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Address
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University of Palermo
Section of General and Thoracic Surgery
Via Liborio Giuffre, 5
POSTAL CODE: 90127
Palermo, Sicily, Italy
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Country
38979
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Italy
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Phone
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+39916552773
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Fax
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+39916552774
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Email
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[email protected]
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Contact person for scientific queries
Name
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Girolamo Geraci
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Address
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University of Palermo
Section of General and Thoracic Surgery
Via Liborio Giuffre, 5
POSTAL CODE: 90127
Palermo, Sicily, Italy
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Country
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Italy
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Phone
38980
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+39916552773
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Fax
38980
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+39916552774
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Email
38980
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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