Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of 123 patients

Abstract

Background/aims: The aim of this study was to investigate the frequency, clinical characteristics, findings and possible varieties of treatment of duodenal diverticula in Finnish patients diagnosed by endoscopic retrograde cholangiopancreatography.

Material and methods: Among 1735 patients investigated by endoscopic retrograde cholangiopancreatography, there were 123 patients with one or more duodenal diverticula and with sufficient clinical data available for this study. Mean age of the patients was 63 years. The male/female ratio was 61/62. Three hundred twenty age and sex matched patients undergoing ERCP during the same time period, but without duodenal diverticula, served as controls.

Results: Sixty-one percent of the diverticula were juxtapapillary. Pain and jaundice were the symptoms indicating ERCP in 62% of patients. Laboratory findings were mostly within normal limits. A hepatic or pancreatic tumor was suspected in twelve patients at ultrasound and computer tomography, and five of them had cancer. In 65 patients, both ducts were cannulated at ERCP. In eleven patients, the finding was normal. There was no significant difference in the incidence of pathologic ERCP findings between the patients with juxtapapillary diverticula and diverticula in other parts of duodenum, except pancreatic duct, which was more frequently abnormal in patients with a non-juxtapapillary diverticulum. The patients with juxtapapillary diverticula had not had previous related complications or operations significantly more often than patients with diverticula in other parts of duodenum. The patients with juxtapapillary diverticula had significantly more often biliary stones at ERCP than control patients and they had idiopathic pancreatitis twice as often as control patients, but the difference was not statistically significant. In three patients, the therapy was directed to the diverticulum and 80 patients had some other treatment.

Conclusion: These data do not reveal any clear correlation between a juxtapapillary diverticulum and pancreato-biliary disorders. However, common bile duct stones were more often found in patients with a juxtapapillary diverticulum than in controls.