Korean J Med.  2000 Jun;58(6):616-625.

Association between lithogenesis and anatomical characteristics of cystic duct and juxtapapillary duodenal diverticulum

• Kim HS
• Park CY

Abstract

BACKGROUND
There are many factors that may affect the lithogenesis. These factors are age, sex, nutrition, diet, hormones, drugs, heredity, infection, etc. Moreover, it is known that morphology, implantaion site, diameter, length of cystic duct may also play an important role in the lithogenesis. It is also known that juxtapapillary duodenal diverticulum is associated with lithogenesis. This study investigated correlation between lithogenesis and anatomical characteristics of cystic duct and juxtapapillary duodenal diverticulum.
METHODS
Between January 1996, and April 1999, 461 endoscopic retrograde cholangiopancreatography were performed. Patients excluded from the study were those with previous cholecystectomy, carcinoma of the pancreas or biliary tract, benign stenosis of the sphincter of Oddi, lack of visualization of the entire cystic duct, and biliary endoprostheses. Finally, 90 patients were included in the study. The length and diameter of cystic duct was measured by means of string. The patients were divided into three groups.(Group I, absence of lithiasis in the biliary tract and gallbladder ; Group II, presence of lithiasis in the gallbladder but not in the CBD; Group III, lithiasis in the CBD with or without gallbladder lithiasis.)
RESULTS
Lithiasis is associated significantly with sex, age, triglyceride level, site of implantation, length of cystic duct, morphology, existence of juxtapapillary duodenal diverticulum. The patients with gallstones or CBD stones(Group II, III) has significantly longer cystic duct than others(Group I) in the length(p< or =0.001). Furthermore, the patient with left marginal insertion of cystic duct on the CBD is associated with a length greater than 3cm(p=0.002) and spiral morphology(p< 0.001).
CONCLUSION
Age, sex, level of triglyceride, implantation site, morphology, length of the cystic duct and juxtapapillary duodenal diverticulum is associated with lithiasis. It seems that left marginal insertion of cystic duct can play an important role in lithogenesis by increasing cystic duct resistance and causing a reduced washout effect of the gallbladder contents.

Keyword

Cystic duct; Diverticulum; Cholelithiasis; Vater's aupulla

MeSH Terms

Biliary Tract
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy
Cholelithiasis
Constriction, Pathologic
Cystic Duct*
Diet
Diverticulum*
Gallbladder
Gallstones
Heredity
Humans
Lithiasis
Pancreas
Sphincter of Oddi
Triglycerides