Incidence and Significance of Periampullary divertucula at Endoscopic retrograde cholangiopancreatography

Yi, Sun Young; Lee, Han Chu; Jung, Hye Kyoung

Abstract

OBJECTIVES
Diverticula on the second part of the duodenum have a 1-5% incidence in barium studies reports. They have been associated to : choledocholithiasis, biliary dysfunction, acute pancreatitis, diverticulitis, duodencolic fistula, bleeding, malabsorption, and bowel obstruction. With forward viewing endoscope diverticula are not easy to see but with side viewing scope are commonly seen and widely accepted as a cause of difficult cannulation and/or sphinterotomy. The purpose of this study is to determine the incidence of periampullary diverticula and to see whether our results are in accordance wtih above statements included in difficult cannulation and/or sphincterotomy at endoscopic retropgrade cholangiography (ERCP) in retrospectively examine our own series. Also to examine their association with biliary and pancreatic diease.
PATIENTS AND METHODS
Three hundred and thirty one consecutive ERCP reports were reviewed with special reference to the following : sex, age, presence of duodenal diverticula, difficulty of cannulation and/or sphinterotomy.
RESULTS
Seventy-nine patients (24%) had one or more periampullary diverticula. Age and sex made no difference. Thirty-two (10.3%) had a difficult or unsuccessful cannulation and only five of those patients (1.6%) had periampullary diverticulum (p<0.001). But the failure rate of large sphincterotomy was more common in patient with periampullary diverticum (73.5%) than without diverticulum (24.6%) (p<0.001). The disease of the patients who had diverticulum, gallstone is the most frequent incidence (77.2%). Diverticulum was more frequently found in choledocholithiasis patients (45.3%) than studied patients (24%).
CONCLUSION
Periampullary diverticula are a common finding during ERCP and less likely to cause a unsuccessful cannulation, but the cause of unsuccessful sphincteromy.