Association of periampullary diverticula with choledocholithiasis - A prospective study

Abstract

Background: Periampullary diverticula are often reported to be associated with lithiasis of biliary tree but it is still unclear whether periampullary diverticula are associated only with choledocholithiasis or not. The aim of this prospective study was to evaluate the association of periampullary diverticulum with common bile duct (CBD) stone, gallbladder (GB) stone or intrahepatic duct (IHD) stone separately. Methods: A total of 632 patients who were to receive endoscopic retrograde cholangiopancreatography (ERCP) because of suspected biliary and pancreatic disease were included. Periampullary diverticula were defined as diverticula which were located around papilla of Vater within 2cm radius. The presence, number and location of periampullary diverticula were evaluated during ERCP. Results: Twenty-one patients with unsuccessful ERCP were excluded and a total of 611 patients were analyzed. 1. The prevalence of periampullary diverticula was 27% (165/611) and there was no significant sexual difference of prevalence (M:F= 24.6% : 30.0%. p>0.05). 2. There-was significant increase of prevalence of periampullary diverticula according age. 3. The prevalence of biliary stones according to the presence or absence of periampullary diverticula was as follows. diverticula\stone site GB CBD* IHD GB+CBD IHD+CBD GB+CBD+IHD diverticula (+) 7.9 24.2 2.4 12.1 3.0 1.8 (%) divcerticula (-) 11.2 8.3 5.2 8.4 4.7 1.8 (%) *: p<0.001 4. The prevalence of choledochlithiasis was 24.2% in patients with periampullary divertieulum and 8.3% in patients without periampullary diverticulum and relative risk was 2.9. 5. There was no significant difference of prevalence of choledocholithiasis according to the location and number of periampullary diverticula. Conclusions: These findings suggest that periampullary diverticula are associated only with choledocholithiasis and not with gallbladder lithiasis or intrahepatic duct lithiasis.