title: Size and type of periampullary duodenal diverticula are associated with bile duct diameter and recurrence of bile duct stones.
abstract: OBJECTIVE
  Periampullary diverticula (PAD) are not uncommon findings during endoscopic retrograde cholangiopancreatography, but its clinical significance had not been established. To investigate the clinical characteristics associated with PAD and their relationships with the type and size of PAD in patients with common bile duct (CBD) stones was aimed.
  
  
  METHODS
  Three hundred seventy patients undergoing endoscopic retrograde cholangiopancreatography between March 2010 and July 2012 were consecutively enrolled, and their demographics, laboratory data, and CBD stone-related characteristics according to PAD type and PAD size were analyzed.
  
  
  RESULTS
  Mean age, mean size of CBD stones, prevalence of systemic inflammatory response syndrome, and serum C-reactive protein level differed in patients with CBD stones according to the presence or absence of PAD. The presence of PAD and positive blood culture were correlated with systemic inflammatory response syndrome (P = 0.033 and P < 0.001, respectively). The recurrence of CBD stones was more frequent, and the diameter of CBD was larger in patients with PAD type I than in those with PAD type III. Mean age and CBD diameter were lower in patients with PAD size < 15 mm than those with PAD size ≥ 15 mm. Multivariate analyses indicated that CBD diameter was related to PAD size (P = 0.002) and the recurrence of CBD stones was related to PAD type (P = 0.001).
  
  
  CONCLUSIONS
  PAD are associated with larger CBD stones and severe cholangitis with CBD stones. CBD diameter is related to PAD size, and the recurrence of CBD stones is related to PAD type.
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Chang Whan
authors: CW
authors: Kim
authors: Jae Hyuck
authors: JH
authors: Chang
authors: Ji Hun
authors: JH
authors: Kim
authors: Tae Ho
authors: TH
authors: Kim
authors: In Seok
authors: IS
authors: Lee
authors: Sok Won
authors: SW
authors: Han
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001652:Bile Ducts / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000150:complications*; D004240:Diverticulum / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D004378:Duodenal Diseases / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012720:Severity of Illness Index