title: The clinical importance of different localizations of the papilla associated with juxtapapillary duodenal diverticula.
abstract: BACKGROUND
  Previous studies have evaluated the presence of juxtapapillary duodenal diverticula (JPDD) and the association with pancreatobiliary disease, but not the association of the papilla with an existing JPDD. We investigated the association of different localizations of the papilla with JPDD.
  
  
  METHODS
  We studied patients in whom JPDD was detected during endoscopic retrograde cholangiopancreatography. Patients were classified into 3 groups: 1) papilla located inside the diverticulum, 2) papilla located at the edge of the diverticulum and 3) papilla located closer than 3 cm to the diverticulum. The patients were examined with respect to localization of papilla-diverticula and to the association of the localization with pancreaticobiliary disease.
  
  
  RESULTS
  We enrolled 274 patients in our study. Biliary stone disease more frequently existed in group 3. The number of patients presenting with obstructive jaundice was higher in groups 2 (83.6%) and 3 (83.3%) than group 1 (66%). Cholangitis was more common in group 1 (21.3%) than in groups 2 (6.7%) and 3 (2.3%). The presence of biliary stone disease among patients presenting with pancreatitis was significantly different between groups 1 and 3 (p = 0.013) and between groups 2 and 3 (p = 0.017). The common bile duct more frequently contained stones or sludge in group 3 than in groups 1 and 2.
  
  
  CONCLUSIONS
  When the papilla is located close to the JPDD, the incidence of biliary stone disease decreases, and pancreatobiliary diseases are caused mostly in the absence of biliary stone disease.
authors.affiliation: From the Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
authors.forename: Bunyami
authors.initials: B
authors.lastname: Ozogul
authors.affiliation: From the Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Ozturk
authors.affiliation: From the Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kisaoglu
authors.affiliation: From the Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Aydinli
authors.affiliation: From the Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yildirgan
authors.affiliation: From the Department of General Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey.
authors.forename: Sabri Selcuk
authors.initials: SS
authors.lastname: Atamanalp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000175:diagnosis* / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*