Association of Periampullary Diverticula with Primary Choledocholithiasis but not with Secondary Choledocholithiasis

Myung, Seung Jae; Seo, Dong Wan; Kim, Myung Hwan; Kim, Yeun Suk; Kim, Do Ha; Kim, Hae Kyung; Kim, Hyun Sook; Yu, Hye Seung; Kim, Tae Hyung; Nam, Seung Woo; Lee, Sung Koo; Min, Young Il

Abstract

BACKGROUND/AIMS: Several endoscopie studies found an association between periampuilary diverticula and biliary calculi, however, the results of the reports are inconsistent when considering the anatomical location of the stones. The aims of our study are to evaluate the association between periampullary diverticula and gallstones according to their location iand to clarify the origin of the common bile duct stones by analyzing the composition of the stones.
METHODS
During a period of 10 months, 611 of 632 consecutive cases of endoscopic retrograde cholangiopancreatography(ERCP) were prospectively enrolled. The data of periampullary diverticula and gallstones were analyzed according to the location of the stones. The stones available were initially grouped on the basis of their grass marphology and cross-sectional appearance, and finally analyzed by quantitative infrared spectroscopy.
RESULTS
Diverticula were found in 165 of 611 cases(27.0%) and there was a positive relationship between age and duodenal diverticula(p<0.01). Considering the location of the gallstones, this significance was found only in patients with common bile duct stones not associated with gallbladder or intrahepatic duct stones(p<0.001). Of these 40 cases with gallstones only in common bile duct, 32 had a history of cholecystectomy with more than a two year asymptomatic period following their surgery, and on analysis, most of the stones(30/36, 83%) were classified as brown pigment stones. Therefore, these stones were presumed to be primary common bile duct stones. On the contrary, the common bile duct stones with associated gallbladder or intrahepatic stones were identical with their paired gallbladder or intrahepatic stones in gross and cross-sectional appearance and chemical composition. They were assumed to be secondary common bile duct stones and the difference in prevalence of calculi according to the presence of diverticula was not significant.
CONCLUSION
The prevalence of gallstones was significantly higher in periampullary diverticula, and considering the location and the origin of the gallstones the association between diverticula and gallstones is significant in patients with primary common bile duct stones but not with the secondary ones.