[Low opening of the cystic duct and parapapillary diverticula--a new syndrome?].

The authors proved in a group of 1574 patients (706 men and 868 women) with adequate filling of the bile ducts on endoscopic retrograde cholangiopancreatography (ERCP) that parapapillary diverticula (PPD) are significantly more frequent (p less than 0.001 for both sexes when there is a low opening of the cystic duct, i.e. less than 5 cm above the papilla on X-ray pictures made during ERCP. In women with PPD and a low opening of the cystic duct concrements in the biliary system are significantly more frequent than in PPD with a normal opening (p less than 0.05). The increased incidence of PPD in cases with a low opening of the cystic duct in the authors' patients cannot be ascribed to their age. The low opening of the cystic duct may act as a factor interfering with evacuation of bile and facilitating the formation of hypersaturated bile. During concomitant PPD the low opening of the cystic duct can facilitate and potentiate the action of lithogenic factors known in PPD.