ENDOSCOPIC MANAGEMENT OF CHOLEDOCOLITHIASIS RELATED TO PERIAMPULLARY DUODENAL DIVERTICULA

Aims: Periampullary duodenal diverticula is a subject still widely debated in the literature. Our study aimed to describe the characteristics and the clinical outcomes of a case series of subjects with periampullary duodenal diverticula and bile duct stones, receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP), by comparison to patients having only bile duct stones. Material and methods: 639 consecutive patients with bile duct stones have been investigated through ERCP during 2011 -2016 in a single specialized center of gastrointestinal surgery. Periampullary duodenal diverticula (PADD)'s prevalence reached at 16.9% (n=108 cases). The patients with PADD have been compared to those without PADD, by personal characteristics, pathophysiological mechanisms incriminated in producing symptoms and therapeutic outcomes. Results: Patients with PADD showed a predominance of males, and a significantly older age. Most frequent abnormality was angulation of the terminal CBD group and jaundice occurred in a significantly higher proportion compared to non PADD group. The percentages of successful selective cannulation and sphincterotomy were significantly lower in the PADD group, even comparable to the literature; meanwhile mechanical lithotripsy was required in a higher proportion of cases. Main cause of failure of cannulation was the changed distal track of the duct. The frequency of postoperative complications was like patients without periampullary duodenal diverticula. Conclusions: Therapeutic endoscopic retrograde cholangiopancreatography is obviously a more difficult procedure in the presence of periampullary duodenal diverticula, due to the difficult access to the papilla and the common bile duct, but the success rate remains high even in such cases.