Biliary dilatation in the presence of a periampullary duodenal diverticulum

Lee, J J; Brahm, Gary; Bruni, Silvio G.; Thipphavong, Seng; Sreeharsha, Boraiah

doi:10.1259/bjr.20150149

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…Clinically, PAD has been shown to be associated with biliary diseases because it is believed to contribute to biliary calculi formation [17], especially CBD stones [18]. In the present study, we noticed a higher incidence of biliary calculi in PAD patients (81.91%) compared to non-PAD patients (74.96%), which is consistent with previous observations.…”

Section: Discussionsupporting

confidence: 92%

The role of periampullary diverticulum on the incidence of pancreaticobiliary diseases and the outcome of endoscopic retrograde cholangiopancreatography

et al. 2021

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IntroductionPeriampullary diverticulum (PAD), although commonly discover¬ed in patients undergoing endoscopic retrograde cholangiopancreatograp¬hy (ERCP), remains controversial regarding its role in pancreaticobiliary diseases and the failure rate of cannulation. The aim of this study was to evaluate the association of PAD with pancreaticobiliary diseases and its impact on the outcome of ERCP.Material and methodsA retrospective analysis was carried out on 1455 patients who underwent an ERCP. Patients were divided into a PAD group and a control group without PAD, and propensity score matching was performed to adjust for clinical differences. The comparison was focused on pancreaticobiliary diseases, technical success, and complications of ERCP.ResultsThe occurrence of PAD is associated significantly with increasing age (p < 0.001). Incidences of acute pancreatitis (AP), suppurative cholangitis, and pancreatic head cancer were significantly higher in the PAD group (p < 0.05). After propensity score matching, the PAD group exhibited a higher rate of post-ERCP complications including haemorrhage, post-ERCP pancreatitis (PEP), and hyperamylasaemia (p < 0.05). However, the prevalence of perforation and the success rate of ERCP did not differ between groups (p > 0.05).ConclusionsPeriampullary diverticulum develops with aging and seems to be associated with an increase in pancreaticobiliary diseases and post-ERCP complications except for perforation. Additionally, the presence of PAD does not affect the technical success of ERCP.

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Section: Discussionsupporting

confidence: 92%

The role of periampullary diverticulum on the incidence of pancreaticobiliary diseases and the outcome of endoscopic retrograde cholangiopancreatography

et al. 2021

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“…Kim CW et al [ 25 ] suggested that acute cholangitis patients with PAD had larger CBD stones and more severe cholangitis than those without PAD. However, Lee JJ et al [ 26 ] demonstrated that PAD alone does not lead to abnormal biliary dilatation in age- and sex-matched control groups. Therefore, choledocholithiasis with PAD had different clinical characteristics between Lanzhou and Kyoto.…”

Section: Discussionmentioning

confidence: 99%

Choledocholithiasis characteristics with periampullary diverticulum and endoscopic retrograde cholangiopancreatography procedures: Comparison between two centers from Lanzhou and Kyoto

Zhu¹,

Yue²,

Wang³

et al. 2022

WJGS

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BACKGROUND Most of study regarding periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) therapy for choledocholithiasis based on data from one endoscopy center and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical patients. AIM To compare the choledocholithiasis clinical characteristics between two regional endoscopy centers and analyze impacts of clinical characteristics on ERCP methods for choledocholithiasis patients with PAD. METHODS Patients seen in two endoscopy centers (The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China, and Kyoto Second Red Cross Hospital, Kyoto, Japan) underwent ERCP treatment for the first time between January 2012 and December 2017. The characteristics of choledocholithiasis with PAD were compared between the two centers, and their ERCP procedures and therapeutic outcomes were analyzed. RESULTS A total of 829 out of 3608 patients in the Lanzhou center and 241 out of 1198 in the Kyoto center had choledocholithiasis with PAD. Lots of clinical characteristics were significantly different between the two centers. The common bile duct (CBD) diameter was wider, choledocholithiasis size was lager and multiple CBD stones were more in the Lanzhou center patients than those in the Kyoto center patients (14.8 ± 5.2 mm vs 11.6 ± 4.2 mm, 12.2 ± 6.5 mm vs 8.2 ± 5.3 mm, 45.3% vs 20.3%, P < 0.001 for all). In addition, concomitant diseases, such as acute cholangitis, gallbladder stones, obstructive jaundice, cholecystectomy, and acute pancreatitis, were significantly different between the two centers ( P = 0.03 to < 0.001). In the Lanzhou center, CBD diameter and choledocholithiasis size were lower, and multiple CBD stones and acute cholangitis were less in non-PAD patients than those in PAD patients (13.4 ± 5.1 mm vs 14.8 ± 5.2 mm, 10.3 ± 5.4 mm vs 12.2 ± 6.5, 39% vs 45.3%, 13.9% vs 18.5%, P = 0.002 to < 0.001). But all these characteristics were not significantly different in the Kyoto center. The proportions of endoscopic sphincterotomy (EST), endoscopic balloon dilatation (EPBD), and EST+EPBD were 50.5%, 1.7%, and 42.5% in the Lanzhou center and 90.0%, 0.0%, and 0.4% in the Kyoto center, respectively. However, the overall post-ERCP complication rate was not significantly different between the two centers (8.9% in the Lanzhou and 5.8% in the Kyoto. P = 0.12). In the Lanzhou center, the difficulty rate in removing CBD stones in PAD was higher than in non-PAD group (35.3% vs 26.0%, P < 0.001). But the rate was no significant differen...

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“…Lithiasis tended to occur more frequently among patients with duodenal diverticula than in patients with the major duodenum in normal location. There are only a few reports on the role of diverticula in the pathogenesis of choledocholithiasis [3,11,19,22,33].…”

Section: Discussionmentioning

confidence: 99%

“…These symptoms are often mistaken with signs of peptic ulcer disease [6]. However, DD may be of major clinical importance, especially when they are located close to the major duodenal papilla [22,24]. A few reports have proposed an association between the position of the major duodenal papilla in the diverticulum and an increased frequency of bile duct disease, especially lithiasis and pancreatitis [3,4,9,16,18,19,21,36,38,39].…”

Section: Introductionmentioning

confidence: 99%

The position of a duodenal diverticulum in the area of the major duodenal papilla and its potential clinical implications

et al. 2021

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Background: Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localization of the major duodenal papilla, duodenal diverticula, and some particular clinical issues. Materials and methods: In total, 628 patients (408 females and 220 males; aged 21-91 years), who underwent ERCP (endoscopic retrograde cholangiopancreatography) were included in this study. The patients were divided into two groups: a study group comprising 66 patients (10.5%) with periampullary position of diverticula (Group A), and a control group comprising 562 patients (89.5%) without diverticula (Group B). Results: A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52-91 years) and 25 men (aged 54-83). Conclusions: Three types of localization were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (Type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis.

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Biliary dilatation in the presence of a periampullary duodenal diverticulum

Cited by 10 publications

References 17 publications

The role of periampullary diverticulum on the incidence of pancreaticobiliary diseases and the outcome of endoscopic retrograde cholangiopancreatography

The role of periampullary diverticulum on the incidence of pancreaticobiliary diseases and the outcome of endoscopic retrograde cholangiopancreatography

Choledocholithiasis characteristics with periampullary diverticulum and endoscopic retrograde cholangiopancreatography procedures: Comparison between two centers from Lanzhou and Kyoto

The position of a duodenal diverticulum in the area of the major duodenal papilla and its potential clinical implications

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