Juxtapapillary Duodenal Diverticula Risk Development and Recurrence of Biliary Stone

Abstract

We assessed whether the presence of juxtapapillary duodenal diverticula (JPDD) risks biliary stone disease and recurrence. In total, 695 patients who underwent ERCP were divided into two groups: biliary stone disease (group I, n = 523) and non-stone biliary diseases (group II, n = 172). Additionally, for a control group (group III), 80 age-matched healthy subjects underwent side-view duodenoscopy. In group I, rates of post-ERCP pancreatitis, cannulation failure, and disease recurrence in two-year follow up were compared according to the presence of JPDD. In results, the incidence of JPDD in group I (42.4%) was significantly higher than in group II (16.3%) and III (18.8%). The frequencies of JPDD were increased with age in all groups, and reached statistical significance in group I. In group I, rates of post-ERCP pancreatitis were significantly higher in patients with JPDD (18.5%) compared to JPDD negative (12.6%). The cannulation failure rate was also higher in patients with JPDD (9.9%) compared to JPDD negative (5.3%). Recurrence rate was higher in patients with JPDD (25.3%) compared to JPDD negative (9.2%). In conclusion, JPDD develops with aging and risks biliary stone formation. JPDD also seems to be associated with post-ERCP pancreatitis, cannulation failure and biliary stone recurrence.

The Impact of Duodenal Diverticuli and the Execution of Endoscopic Retrograde Cholangiopancreaticography

“…It is reported in the literature that stones in the common bile duct occur significantly more often in patients with diverticuli [12, 13], indicating that the anatomical abnormality and malfunction of the sphincter of Oddi possibly play an important role in the formation of stones [14]. Also periampullary diverticuli are associated with larger stones and severe cholangitis [15, 16].…”

Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly

“…In the elderly, a weakened wall and increased luminal pressure may facilitate outpouching of the duodenal mucosa through the vulnerable spot. 18,19 Pathologic mechanisms through which Lemmel's syndrome is thought to occur include the following. First, diverticulitis or direct mechanical irritation of diverticulum cause distal CBD or ampulla directly compressed mechanically by PAD.…”

Differences in Clinical Characteristics between Juxtapapillary Duodenal Diverticulum and Intradiverticular Papillae

“…They develop extraluminal outpouching of the duodenal wall through locus minoris resistance, and their incidence increases with age 5) . Both JPDD and IPD are often complicated with hepato-biliary-pancreatic diseases because of their anatomical proximity to the papilla Vateri [1][2][3][4][5][6] . The incidence of JPDD including IPD and hepato-biliary-pancreatic diseases (i.e., liver disfunction, cholecystitis, cholelithiasis, and pancreatitis) also increases with age 5,6) .…”

“…- 731 -日本外科系連合学会誌 第 41 巻 ５ 号 It has been suggested that mechanical obstruction of the common bile and pancreatic ducts is caused by JPDD including IDP 6) . Moreover, Oddi dysfunction has been found in patients with JPDD and IDP [7][8][9] .…”

“…Clinical studies of JPDD including IDP have been . [1][2][3]6,7,10) reported as JPDD by many researchers Therefore, there are few reports of the differences in clinical characteristics between patients with JPDD excluding IDP and IDP patients. In order to clarify differences in the clinical characteristics between JPDD patients excluding IDP and only IDP patients, we compared these 2 groups.…”