Periampullary diverticula cause pancreatobiliary reflux.
BACKGROUND
Periampullary diverticula are associated with dysfunction of the sphincter of Oddi. Papillary dysfunction may allow reflux of pancreatic juice as well as intestinal contents into the common bile duct. We prospectively investigated pancreatobiliary reflux in patients with and without periampullary diverticula.


METHODS
The ductal bile was sampled for amylase concentration during endoscopic retrograde cholangiopancreatography in 47 patients with choledocholithiasis (n = 29; with (n = 14) or without (n = 15) periampullary diverticula) or gallbladder cholesterol polyps (n = 18; with (n = 6) or without (n = 12) diverticula).


RESULTS
The amylase concentration within the ductal bile was significantly higher in choledocholithiasis patients with periampullary diverticula (1621 +/- 587 IU/l) than in those without diverticula (1155 +/- 418 IU/l). The amylase concentration tended to be higher in gallbladder polyp patients with diverticula (1087 +/- 275 IU/l) than in those without diverticula (833 +/- 272 IU/l). Irrespective of the presence or absence of diverticula, patients with bile duct stones had significantly higher amylase concentrations than those with gallbladder polyps.


CONCLUSIONS
Periampullary diverticula cause pancreatobiliary reflux. Further investigation is required to determine the clinical implication of pancreatobiliary reflux.
Sugiyama
M
M
The First Dept. of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. sgym@kyorin-u.ac.jp
Atomi
Y
Y
D014670:Ampulla of Vater; D000681:Amylases / Q000032:analysis; D001646:Bile / Q000737:chemistry; D001655:Bile Reflux / Q000209:etiology*; D016022:Case-Control Studies; D003137:Common Bile Duct Diseases / Q000150:complications*; D004240:Diverticulum / Q000150:complications*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications; D042882:Gallstones / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000150:complications; D011446:Prospective Studies
D000681:Amylases