Juxtapapillary Duodenal Diverticula Risk Development and Recurrence of Biliary Stone

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

• 1 Zoepf T, "The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients" 54 : 56-61, 2001
• 2 van der Spuy S, "The relationship between juxtapapillary diverticula and biliary calculi. An endoscopic study" 11 : 197-202, 1979
• 3 Skar V, "The duodenal bacterial flora in the region of papilla of Vater in patients with and without duodenal diverticula" 24 : 649-656, 1989
• 4 Shocket E, "Small bowel obstruction due to enterolith (bezoar) formed in a duodenal diverticulum: a case report and review of the literature" 77 : 621-624, 1982
• 5 Kim DI, "Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy" 54 : 42-48, 2001
• 6 van Basten JP, "Relationship between duodenal diverticuli, gallstones and duodenal and pancreaticobiliary disorders" 140 : 1122-1125, 1996
• 7 van Nieuwkoop C, "Recurrent bacterial cholangitis due to a juxtapapillary diverticulum" 14 : 189-190, 2002
• 8 Uomo G, "Periampullary extraluminal duodenal diverticula and acute pancreatitis: an underestimated etiological association" 91 : 1186-1188, 1996
• 9 Sugiyama M, "Periampullary diverticula cause pancreatobiliary reflux" 36 : 994-997, 2001
• 10 Lobo DN, "Periampullary diverticula and pancreaticobiliary disease" 86 : 588-597, 1999
• 11 Pereira-Lima JC, "Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms" 48 : 457-464, 1998
• 12 Boix J, "Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula" 16 : 208-211, 2006
• 13 Lane JE, "GI bleeding from duodenal diverticula" 96 : 2799-2800, 2001
• 14 Miyazaki S, "Function of the sphincter of Oddi in patients with juxtapapillary duodenal diverticula: evaluation by intraoperative biliary manometry under a duodenal pressure load" 19 : 307-312, 1995
• 15 Yoneyama F, "Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: report of three cases" 11 : 69-72, 2004
• 16 Katsinelos P, "Endoscopic sphincterotomy in patients with “acalculus” cholangitis associated with juxtapapillary diverticula" 51 : 649-651, 2004
• 17 Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus" 37 : 383-393, 1991
• 18 Leivonen MK, "Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of 123 patients" 43 : 961-966, 1996
• 19 Chang-Chien CS, "Do juxtapapillary diverticula of the duodenum interfere with cannulation at endoscopic retrograde cholangiopancreatography? A prospective study" 33 : 298-300, 1987
• 20 Pimparkar BD, "Diverticulosis of the small intestine, In Gastroenterology. 3rd ed" WB Saunders 437-458, 1976
• 21 Cheshire NJ, "Diverticula, volvulus, superior mesenteric artery syndrome and foreign bodies, In Maingoats abdominal operation. 10th ed" Prentice Hall International (UK) Limited 916-921,
• 22 Harford WV, "Diverticula of the hypopharynx and esophagus, the stomach and small bowel, In Sleisenger and Fordtran’s gastrointestinal and liver diseases. 6th ed" WB Saunders 313-316, 1998
• 23 Psathakis D, "Clinical significance of duodenal diverticula" 178 : 257-260, 1994
• 24 Kim MH, "Association of periampullary diverticula with primary choledocholithiasis but not with secondary choledocholithiasis" 30 : 601-604, 1998