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.