Is there a link between periampullary diverticula and biliopancreatic disease? An EUS approach to answer the question

Bruno, Mauro; Ribaldone, Davide Giuseppe; Fasulo, R.; Gaia, Silvia; Marietti, Milena; Risso, À.; Stradella, Davide; Strona, S.; Saracco, Giorgio Maria; Angelis, C.G. De

doi:10.1016/j.dld.2018.07.034

Cited by 9 publications

(6 citation statements)

References 34 publications

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“…A recent study by Bruno et al [5] confirmed an association between diverticula and choledocholithiasis, cholangitis and common bile duct dilatation in an Endoscopic Ultrasound (EUS) study of the prevalence of DD. In addition, no significant association was found between the presence of DD and acute, recurrent or chronic pancreatitis, as in the present study.…”

Section: Primary Choledocholithiasis Was Detected Less Frequently In mentioning

confidence: 85%

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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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Section: Primary Choledocholithiasis Was Detected Less Frequently In mentioning

confidence: 85%

“…Second, it is possible that diverticula cause the sphincter to spasm, thereby increasing biliary duct pressure that may in turn produce jaundice and cholangitis, as well as increase the chance of biliary stone formation. Finally, DD can compress the distal part of the common bile duct, causing functional biliary stasis [2,5,35].…”

Section: Discussionmentioning

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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“…During duodenoscopy, the presence of peripapillary diverticulum and peripapillary fistula was recorded. Peripapillary diverticulum was defined as the presence of a diverticulum within 2 cm radius from the papilla, it is known that duodenal diverticulum is associated with choledocholithiasis and cholangitis 8,9 . Peripapillary fistula is a common complication of common bile duct stones and it is related to cholangitis 10 .…”

Section: Methodsmentioning

confidence: 99%

Lito impactado en la papila duodenal como factor de riesgo en enfermedad pancreatobiliar

González-González¹,

Jáquez-Quintana²,

Borjas-Almaguer³

et al. 2020

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An impacted bile duct stone at duodenal papilla or impacted papillary stone (IPS) is an infrequent presentation of choledocholitiasis. It is unknown if the IPS is a risk factor for acute cholangitis (AC) or acute pancreatitis (AP). We performed a retrospective case-control study comparing patients with IPS and patients with choledocholithiasis during endoscopic retrograde cholangiopancreatography (ERCP). We included 363 patients with choledocholithiasis during ERCP. Thirty-one patients presented IPS during the ERCP. The mean age was 46 years (range 14-89 years), six patients had cholecystectomy background, and 24 cases were female. AC was observed in 15 cases and AP was diagnosed in nine patients. The association between IPS was significant on the AC group odds ratio 4.14, p < 0.01, but not significant on the AP group. IPS is a risk factor to develop AC. Endoscopic stone removal should be performed.

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“…Periampullary diverticulum refers to the saclike process formed within a radius of about 3cm around the large duodenal nipple. At present, the existence of periampullary diverticulum and choledocholithiasis, cholangitis, and choledochal dilatation is considered to be significantly related [16]. Other studies have shown that patients with common bile duct stones are more likely to be found combined with periampullary diverticulum and that the periampullary diverticulum is only related to common bile duct stones but not to gallbladder stones [17].…”

Section: Introductionmentioning

confidence: 99%

Effect of Periampullary Diverticulum on Biliary Flora and the Formation of Common Bile Duct Stone

Hou¹,

Wang²,

Zhang³

et al. 2020

Preprint

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Background: Bile duct stone is closely related to periampullary diverticulum, but it is not clear whether the formation of it was affected by the diverticulum through the biliary flora. To explore the diversity and correlation of biliary and intestinal flora in the patients with choledocholithiasis and the effects of periampullary diverticulum on the flora and bile duct stone. Methods: Bile and intestinal fluid were collected from patients with primary common bile duct stones, and then divided into diverticulum group and none- diverticulum group according to the presence or absence of paravertebral diverticula, DNA of these samples was extracted and a bacterial gene library was constructed, and related bioinformatics analysis was performed after high-throughput sequencing to obtain the bacterial components and community structure of the sample. Result: A total of 3001,613 valid sequences were obtained, with an average of 136436.95±3696.842 sequences, which were classified into 6021 ASV/OUT. Alpha diversity analysis showed that the species richness and diversity in the diverticulum group were lower than those in the nondiverticulum group. According to the species annotation results, the advantage bacterium group of the bile is Proteobacteria (BG 80.41%, Bg 70.95%), and advantage bacterium group of the intestinal fluid is Firmicutes and Proteobacteria (BG 89.39%, Bg 74.11%). A large proportion of Enterobacter was found in bile. Escherichia coli, Klebsiella, Streptococcus and other bacteria closely related to stone formation have been found. The proportion of E. coli in the diverticulum group was increased and due to the existence of the diverticulum Enterobacteria in the bile were increased and more complex. The bacteria that produce Betaglucuronidase are found to be increased in bile. Due to the influence of the periampullary diverticulum, the intestinal flora will be changed and then the biliary flora will also change. Conclusion: The existence of periampullary diverticulum will affect the biliary tract flora and lead to the increase of bacteria related to stone formation, which will affect the formation of choledocholithiasis and make it easier for choledocholithiasis to form.

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Is there a link between periampullary diverticula and biliopancreatic disease? An EUS approach to answer the question

Abstract: Whereas PADs were linked with history of cholangitis, CBD stones and dilation, no association was found with pancreatic diseases.

Cited by 9 publications

References 34 publications

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

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

Lito impactado en la papila duodenal como factor de riesgo en enfermedad pancreatobiliar

Effect of Periampullary Diverticulum on Biliary Flora and the Formation of Common Bile Duct Stone

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