%0 Journal Article
%T ERCP Features and Outcome in Patients with Periampullary Duodenal Diverticulum
%A Amir Houshang Mohammad Alizadeh
%A Esmaeil Shamsi Afzali
%A Anahita Shahnazi
%A Mirhadi Mousavi
%A Siavash zafar Doagoo
%A Dariush Mirsattari
%A Mohammad Reza Zali
%J ISRN Gastroenterology
%D 2013
%R 10.1155/2013/217261
%X Background. Although periampullary diverticulum is usually asymptomatic and discovered incidentally in patients during endoscopic retrograde cholangiopancreatography (ERCP), it may lead to post-ERCP morbidity. We compared baseline characteristics and clinical data as well as ERCP results in patients with and without periampullary diverticulum. Methods. Clinical, laboratory, and ERCP data of 780 patients referred to the Taleghani Hospital, as a great referral endoscopy center, in Iran were prospectively analyzed. Results. The periampullary diverticulum was identified in 44 patients (5.6%). Cannulation of common bile duct was more failed in patients with diverticulum compared to others (35.5% versus 11.5, ). Patients with diverticulum had eight times more often common bile duct stone compared to patients without diverticulum (54.5% versus 12.2%, ). Post-ERCP complications were observed in 2.3% and 4.2% of patients with and without diverticulum, respectively, which did not significantly differ in both groups. Conclusion. Because of more failure cannulation in the presence of periampullary diverticulum, ERCP requires more skills in these patients. Prevalence of common bile duct stone was notably higher in patients with diverticulum; therefore, more assessment of bile stone and its complications in these patients is persistently recommended. 1. Introduction Periampullary diverticulum is commonly situated on the second part of the duodenum and usually occurred in the elderly, with a slight female preponderance [1, 2]. It is usually caused by the progression of duodenal motility disorders. Furthermore, progressive weakening of intestinal smooth muscles and increased intraduodenal pressure have been known as main underlying etiologies for this defect [3]. The incidence of this finding widely varies from 1% to 32.8% based on different diagnostic approaches such as barium graphs, endoscopic retrograde cholangiopancreatography (ERCP) evaluation, and autopsy series [4¨C7]. Although periampullary diverticulum is usually asymptomatic and discovered incidentally in patients during ERCP, its association with various pathological conditions such as choledocholithiasis, perforation, pancreatitis, bleeding, CBD obstruction, and rarely carcinoma has been well recognized in various studies [8¨C12]. One of the most important problems to the endoscopists is the impact of these diverticula on the success of therapeutic or diagnostic ERCP procedures. In some reports, cannulation difficulty during ERCP was associated with the presence of periampullary diverticulum [3] and, in some
%U http://www.hindawi.com/journals/isrn.gastroenterology/2013/217261/