title: ERCP in patients with periampullary diverticulum.
abstract: OBJECTIVE
  Duodenal diverticula, discovered incidentally in patients during endoscopic retrograde cholangiopancreatography, are usually asymptomatic, but can be the source of significant morbidity. The aim of this study was to evaluate the indications for endoscopic retrograde cholangiopancreatography, the course of this procedure and complications after this procedure in patients with periampullary diverticulum.
  
  
  METHODS
  Clinical, laboratory, ultrasonographic, and endoscopic retrograde cholangiopancreatography data of 626 patients from a single endoscopy center were retrospectively analyzed.
  
  
  RESULTS
  The periampullary diverticulum was identified in 72 patients (11.5%). The difficulty in cannulation of papilla of Vater was encountered in 57 patients (79.2%) with diverticulum compared to 54 patients (9.7%) without diverticulum (P < 0.001). Cannulation of common bile duct was successful in 592 patients (94.6%). Cannulation of common bile duct failed in 8 patients (11.1%) with diverticulum compared to 26 patients (4.7%) without diverticulum (P = 0.046). Patients without diverticulum (n = 168, 31.9%) had two-times more often dilated common bile duct > or = 6 mm without stone on ultrasound compared to patients with diverticulum (n = 12, 17.6%) (P = 0.017). Patients with diverticulum presented 1.8-times more often with retained stone in the common bile duct than patients without diverticulum (16.7% vs. 9.7%). 17.3% of patients developed post-endoscopic retrograde cholangiopancreatography complications, which did not significantly differ in both groups. However, the patients who presented with retained common bile duct stones had higher post-endoscopic retrograde cholangiopancreatography complications (P = 0.011).
  
  
  CONCLUSIONS
  Cannulation of the common bile duct is more difficult in patients with periampullary diverticulum and requires more skills. Periampullary diverticulum is also associated with higher risk of retained stones in the common bile duct which may lead to higher post-endoscopic retrograde cholangiopancreatography complication rate.
authors.affiliation: Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. rajnakova@yahoo.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Rajnakova
authors.forename: Peter M
authors.initials: PM
authors.lastname: Goh
authors.forename: Sing Shang
authors.initials: SS
authors.lastname: Ngoi
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D003137:Common Bile Duct Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000175:diagnosis*; D004378:Duodenal Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography