The clinical importance of different localizations of the papilla associated with juxtapapillary duodenal diverticula

• Published in: Canadian Journal of Surgery 2014-10, Vol.57 (5), p.337-341
• Main Authors: Ozogul, Bunyami, MD, Ozturk, Gurkan, MD, Kisaoglu, Abdullah, MD, Aydinli, Bulent, MD, Yildirgan, Mehmet, MD, Atamanalp, Sabri Selcuk, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ampulla of Vater - surgery; Biliary tract diseases; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis - complications; Cholelithiasis - diagnosis; Cholelithiasis - surgery; Colorectal diseases; Diagnosis; Diagnosis, Differential; Diverticulum - diagnosis; Diverticulum - surgery; Duodenal Diseases - complications; Duodenal Diseases - diagnosis; Duodenal Diseases - surgery; Endoscopic surgery; Endoscopy; Female; Follow-Up Studies; Gastrointestinal diseases; Health aspects; Humans; Male; Medical treatment; Middle Aged; Pancreas; Patients; Prognosis; Retrospective Studies; Sphincterotomy, Endoscopic - methods; Studies; Surgery
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.021113

Background Previous studies have evaluated the presence of juxtapapillary duodenal diverticula (JPDD) and the association with pancreatobiliary disease, but not the association of the papilla with an existing JPDD. We investigated the association of different localizations of the papilla with JPDD. Methods We studied patients in whom JPDD was detected during endoscopic retrograde cholangiopancreatography. Patients were classified into 3 groups: 1) papilla located inside the diverticulum, 2) papilla located at the edge of the diverticulum and 3) papilla located closer than 3 cm to the diverticulum. The patients were examined with respect to localization of papilla–diverticula and to the association of the localization with pancreaticobiliary disease. Results We enrolled 274 patients in our study. Biliary stone disease more frequently existed in group 3. The number of patients presenting with obstructive jaundice was higher in groups 2 (83.6%) and 3 (83.3%) than group 1 (66%). Cholangitis was more common in group 1 (21.3%) than in groups 2 (6.7%) and 3 (2.3%). The presence of biliary stone disease among patients presenting with pancreatitis was significantly different between groups 1 and 3 ( p = 0.013) and between groups 2 and 3 ( p = 0.017). The common bile duct more frequently contained stones or sludge in group 3 than in groups 1 and 2. Conclusion When the papilla is located close to the JPDD, the incidence of biliary stone disease decreases, and pancreatobiliary diseases are caused mostly in the absence of biliary stone disease.