The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients.

BACKGROUND

Data concerning the association of juxtapapillary duodenal diverticula (JPDD) with biliopancreatic disorders are inconsistent, but an association between bile duct stones and JPDD is widely accepted. The aim of this study was to investigate the frequency of JPDD and its association with biliopancreatic disorders in patients undergoing ERCP.

METHODS

A retrospective analysis was conducted of 5497 consecutive ERCP procedures performed in 2925 patients. Matched-pair analysis yielded 350 pairs of patients with and without JPDD, matched for definite risk criteria such as age, gender, and indication for ERCP.

RESULT: The incidence of JPDD was 12%. Patients with JPDD were significantly older than patients without JPDD (71 vs. 62 years; p < 0.0019) and had a significantly higher bleeding rate after endoscopic sphincterotomy (8.8% vs. 4.8%; p = 0.039). The presence of JPDD correlated with gallbladder stones (29.4% vs. 20.8%; p = 0.039), bile duct stones (46% vs. 33.1%; p < 0.001), and recurrence of bile duct stones (6.6% vs. 1.4%; p = 0.002). There were no significant differences in frequency of acute and chronic pancreatitis as well as pancreas divisum. After multivariate logistic regression analysis, technically difficult ERCP, bleeding after endoscopic sphincterotomy, and bile duct stones remained as independent risk factors.

CONCLUSION

JPDD appears to be a risk factor for complications of endoscopic sphincterotomy and for gallbladder stones, bile duct stones, and their recurrence.