Duodenal diverticuli: do they predispose for Common Bile Duct (CBD) pathology?

Abstract

INTRODUCTION: Periampullary duodenal diverticuli (PDD) are extra luminal mucosal out pouching of duodenum arising adjacent to or containing the ampulla of Vater or intraluminal portion of CBD . Juxta-papillary duodenal diverticuli (JPDD) are defined as diverticuli located with in radius of 2 cm of major papilla but not involving them. We note that patients with 'DD have a higher tendency for stone formation and biliary complications. METHODS: 100 consecutive patients who underwent ERCP at the National Hospital Sri lanka in 2011 were included in this study. The incidence of DD, position , associated pathology ,difficulty index, special procedures, outcome and complications were noted. RESULTS: 26 patients had DD. 18 had PDD and 6 JPDD. 12/18 of PDD and 4/6 JPDD had common bile duct stones. 1/26 an ERCP could not be. performed and had open CBD exploration. In 6/18 with PDD a hurricane balloon dilatation of the papilla was done instead of sphincterotomy. There · was one hilarcholangio cancer and 2 pancreatic cancers and 4 pancreatitis patients. Patients with stone disease were managed with total endoscopic procedures in 23/24. CONCLUSIONS: Patients with PDD and JPDD have a high incidence of CBD stones disease. .A papillary manometry study could be undertaken to ascertain the biliary sphincter pressures in patients with PDD.