Analysis of Endoscopic Sphincterotomy in Patients with Periampullary Diverticulum: according to the Location of the Diverticulum

Yoon, Hyun Ah; Roh, Myung Hwan; Baek, Yang Hyun; Kim, Yung Hoon; Yoo, Hyun Seung; Lee, Sung Wook; Jang, Jin Seok; Lee, Jong Hun; Han, Sang Yung; Choi, Seok Reyol

Abstract

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) involves more complications and medical problems when a periampullary diverticulum (PD) is present. The data about EST for treating a small population of PD patients is controversial and any recent data is rare. The aim of this study is to evaluate the results of performing EST for a large population of PD patients.
METHODS
We retrospectively enrolled 178 patients with PD and 178 patients without PD and these patients underwent EST for removal of common bile duct (CBD) stones during the years 2003~2005 at Dong-A University Hospital. We classified PD patients, according to the location of the ampulla and diverticulum, into 3 groups and we considered removal of the CBD stones as success.
RESULTS
The success rates of EST in the two groups were similar: 91.0% in the PD group and 98.8% in the control group (p=0.0341). Failures were more frequently observed when the papilla was located inside of the diverticulum than for the other locations (p=0.0341). The complications cholangitis and pancreatitis after EST were similar for the two groups, but bleeding was more frequently observed in the PD group (p=0.0067).
CONCLUSIONS
More skill for performing EST is needed to prevent bleeding in PD patients and it is more difficult to remove CBD stones when the papilla was located inside of the diverticulum.