ABSTRACT
Introduction: Periampullary diverticula (PAD) are mucosal outpouchings commonly situated on the medial aspect of second part of duodenum; usually within 2-3 cm of the ampulla of vater. PAD are usually asymptomatic incidental findings during side viewing scopy. We aimed to analyze the influence of PAD in the management of patients who underwent ERCP during past 6 years in our centre. Materials and methods: Patients between the ages of 13 and 74 with the diagnosis of pancreaticobiliary diseases who underwent ERCP at Institute of medical gastroenterology, Madras Medical College from January 2012 to December 2017 were taken into account for retrospective analysis. We assessed and compared ERCP results in patients with and without PAD. Results: A total of 3412 patients underwent ERCP that of these 197(5.77%) patients had PAD. Among the 3412 cases , the incidences of PAD in patients age group less than 50 years was 2.6% and age group more than 50 years was 8.1%(P<0.001). Successful biliary cannulation was achieved in 79.18% (n=156) of patients with PAD and 93.1% of patients of patients without PAD (P<0.001). Of that in patients with PAD, for 28.93 %( n=57) cases underwent precut needle papillotomy. The papilla Rabindranath Eswaran, Premkumar Karunakaran, Allwin James, Venkateswaran Arcot Rajeswaran, Rajkumar Solomon. A study on periampullary diverticula – 6 years ERCP experience from a referral centre. IAIM, 2018; 5(6): 20-26. Page 21 was undetectable in 6 cases with PAD. Incidence of PAD was higher in choledocholithiasis group (9.2% vs 4.1%, p=0.003), but in incidence of CBD stricture had no difference. Complete clearance of CBD stones was achieved lesser in patients with PAD (72.4% vs 86.8% P=0.02). Conclusion: The frequency of PAD increases with age and occurs more in choledocholithiasis cases. Our experience showed decreased rate of cannulation success with PAD, increased difficulty in cannulation and decreased rate of successful stone retrieval.
ABSTRACT
Introduction: Choledochal cyst is a type congenital anomaly in which there is dilatation of the intra or extrahepatic biliary tree. Choledochal cysts are classified into five types based on location or shape of the cysts. Materials and methods: A prospective analytical study was conducted from January 2015 to June 2017 at Madras Medical College, Chennai, India. All patients who underwent ERCP and had finding of choledochal cyst on cholangiogram were included in the study. Patients were assessed on their demographic data, clinical findings, presentation, and complications. Results: The incidence of symptomatic choledochal cyst was 2.5%. Type 1C was the most common type of choledochal cyst with obstructive jaundice due to large CBD stones as the most common presentation in this study. None had 30 day post-operative mortality. Conclusion: Type IC is the most common type among symptomatic choledochal cyst in south India. As it is a premalignant condition management includes endoscopic retrograde cholangiography followed by surgery with good clinical outcome.