title: [The effect of periampullary diverticulum on the outcome of bile duct stone treatment with endoscopic papillary large balloon dilation].
abstract: OBJECTIVE
  Periampullary diverticulum (PAD) causes difficulty in the extraction of common bile duct (CBD) stones with conventional endoscopic therapy. Our study was designed to evaluate the effect of PAD on endoscopic large balloon dilation (EPLBD) with/without limited endoscopic sphincterotomy (EST) for CBD stone treatment.
  
  
  METHODS
  We retrospectively reviewed cases of 141 patients treated CBD stones by EPLBD with/without limited EST at Gachon Gil Medical Center from September 2008 to February 2010. PAD were classified into three groups according to the location of the papilla and diverticulum. Clinical parameters, endoscopic parameters, and procedure outcomes were analyzed.
  
  
  RESULTS
  PAD were identified in 46.1% (65/141), with 23 male (35.4%) and 42 female (64.6%) and a mean age of 72.9±11.1 years. Mean diameter of the stones was 14.8±6.0 mm and mean diameter of CBD was 21.6±7.7 mm. PAD group was significantly older than control group (72.9 vs. 68.6, p=0.043) and the incidence of large stone (≥15 mm) was higher in PAD group (60.0% vs. 42.1%, p=0.034). Success rate of complete removal of stones in the first session was 32/65 patients (49.2%) and overall successful complete stone removal rates was 63/65 (96.9%). There was no significant difference between the PAD and control groups in success rate. Major complications were similar between two groups.
  
  
  CONCLUSIONS
  PAD is associated with an increased incidence of large bile duct stones and older age. PAD seems to not increase technical failure rate or complication risk on EPLBD with/without limited EST.
authors: Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
authors: Ji Won
authors: JW
authors: Lee
authors: Jung Ho
authors: JH
authors: Kim
authors: Yeon Suk
authors: YS
authors: Kim
authors: Hyun Seok
authors: HS
authors: Choi
authors: Ju Seung
authors: JS
authors: Kim
authors: Seok Hoo
authors: SH
authors: Jeong
authors: Min Su
authors: MS
authors: Ha
authors: Yang Suh
authors: YS
authors: Ku
authors: Yun Soo
authors: YS
authors: Kim
authors: Ju Hyun
authors: JH
authors: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000033:anatomy & histology; D004240:Diverticulum / Q000175:diagnosis*; D004378:Duodenal Diseases / Q000175:diagnosis*; D005260:Female; D042882:Gallstones / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome