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VOLUME 6 , ISSUE 1 ( January-June, 2016 ) > List of Articles

RESEARCH ARTICLE

Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma

Necati Örmeci, Xheni Deda, Çağdaş Kalkan, Ali Emrehan Tüzün, Fatih Albayrak, Abdulkadir Dökmeci, D Kadir Bahar

Citation Information : Örmeci N, Deda X, Kalkan Ç, Emrehan Tüzün A, Albayrak F, Dökmeci A, Kadir Bahar D. Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma. Euroasian J Hepatogastroenterol 2016; 6 (1):31-34.

DOI: 10.5005/jp-journals-10018-1162

License: CC BY-NC 4.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Introduction: Periampullary diverticula (PD) is caused by extraluminal pouching of duodenal mucosa. Using a very common endoscopic procedure to diagnose or treat gastrointestinal disorders, we encountered duodenal diverticulum. Materials and methods: This is a retrospective, single-center study. Three thousand and sixteen patients on whom endoscopic retrograde cholangiopancreatography (ERCP) was performed at Ankara University Medical School, Department of Gastroenterology, from June 2009 to June 2014 were included to the study. Results: Hundred and thirty patients (males 65, females 65) among the 3,016 had PD. Two hundred and sixty patients without diverticulum were randomly chosen from the 3,016 patients, as a control group [121 (47%) females, 139 (53%) males]. There was no statistical difference between the two groups. The mean age of the patients with PD was 69.9 years, while the mean age was 62.3 years for patients without PD (p < 0.001). Incidence for PD was 4.6%. The papilla of Vater was located in the inter-diverticular area (Type 1) in 9 patients (8.3%), at the edge of the diverticulum (Type 2) in 31 patients (28.4%), and at a distance of 2 to 3 cm from the papilla (Type 3) in 69 patients (63.3%). Discussion: Although numerically more common bile duct stones occurred in patients with PD compared to those without PD, there was no statistical difference between the two groups. The rate of pancreatobiliary carcinomas was higher in patients without diverticulum. Cannulation was successful in both groups at the rate of 97.6 and 92% respectively, but cannulation failed more often in patients without PD. Duodenal perforation occurred in one patient with PD. Bleeding after sphincterotomy occurred in two patients without PD.


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  1. Kim CW, Chang JH, Kim TH, Lee IS, Han SW. Size and type of periampullary duodenal diverticula are associated with bile duct diameter and recurrence of bile duct stones. J Gastroenterol Hepatol 2013 May;28(5):893-898
  2. The role of juxtapapillary duodenal diverticula in biliary stone disease. Gastrointest Endosc 2002 Apr;55(4):543-547
  3. Periampullary diverticula: consequences of failed ERCP. Ann R Coll Surg Engl 1998 Sep; 80(5):326-331
  4. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones. World J Surg 2012 Nov; 36(11):2666-2669
  5. Additional biliary cannulation methods in patients with juxtapapillary duodenal diverticula. Dig Dis Sci 2012 Nov;57(11):2982-2987
  6. Therapeutic management of juxtapapillary duodenal diverticulum. Cir Esp 2013 Aug-Sep;91(7):463-465. Necati Örmeci et al 34 7. Mallappa S, Jiao LR. Juxtapapillary duodenal diverticulum masquerading as a cystic pancreatic neoplasm. J R Soc Med Sh Rep 2011 Nov;2(11):89-91
  7. Juxtapapillary duodenal diverticula and pancreatobiliary disease. Dig Surg 2010;27(2):105-109
  8. The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients. Gastrointest Endosc 2001 Jul;54(1):56-61
  9. The role of juxtapapillary duodenal diverticulum in the formation of gallbladder stones. Hepatogastroenterology 1988 Jul-Aug;45(22):917-920
  10. Relationship between perivaterian diverticulum and biliary tract disease. Gastroenterol Jpn 1985 Dec;20(6):577-581
  11. Relationship between juxtapapillary duodenal diverticula and biliopancreatic disease–evaluation by endoscopic biliary manometry. Nihon Shokakibyo Gakkai Zasshi 1992 May;89(5):1270-1278
  12. Function of the sphincter of Oddi in patients with juxtapapillary duodenal diverticula: evaluation by intraoperative biliary manometry under a duodenal pressure load. World J Surg 1992 Mar-Apr;19(2):307-312
  13. Studies of the choledocho-duodenal sphincter in patients with and without juxta-papillary duodenal diverticula. Scand J Gastroenterol 1980;15(7):875-880
  14. Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula. Scand J Gastroenterol 1989 Mar;24(2):205-212
  15. The duodenal bacterial flora in the region of papilla of Vater in patients with and without duodenal diverticula. Scand J Gastroenterol 1989 Aug; 24(6):649-656
  16. Association between juxtapapillary diverticulum and acute cholangitis determined using laboratory data. Clin Exp Gastroenterol 2014 Nov 20;7: 447-451
  17. Juxtapapillary duodenal diverticula risk development and recurrence of biliary stone. J Korean Med Sci 2012 Jul;27(7):772-776
  18. Acute pancreatitis due to an impacted juxtapapillary duodenal diverticulum. Endoscopy 2012;44 (Suppl 2):E180-E181
  19. Recurrent bacterial cholangitis due to a juxtapapillary diverticulum. Eur J Gastroenterol Hepatol 2002 Feb;14(2):189-190
  20. Impact of periampullary diverticula on the outcome and fluoroscopy time in endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int 2013 Aug;12(4): 408-414
  21. Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Endoscopy 2004 Dec;36(12):1050-1053
  22. Periampullary diverticula: consequences of failed ERCP. Ann R Coll Surg Engl 1998 Sep; 80(5):326-331
  23. ERCP for intradiverticular papilla: two-devices-in-one-channel method. Endoscopic Retrograde Cholangiopancreatography. Gastrointest Endosc 1998 Nov;48(5):517-520
  24. ERCP features and outcome in patients with periampullary duodenal diverticulum. ISRN Gastroenterol 2013 Jul28; 2013:217261.
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