J Korean Geriatr Soc.  2007 Mar;11(1):17-23.

Cholestatic Jaundice Associated with Juxtapapillary Diverticula without Common Bile Duct Stones

• Kim SJ
• Wang JH
• Lee JD
• Moon ES
• Kim KR
• Lee TU
• Kweon HJ
• Sin HJ
• Rho KB

Abstract

BACKGROUND/AIMS: Cholestatic jaundice caused by a juxtapapillary diverticulum can be treated by excision of the diverticula or endoscopic sphincterotomy(EST). The aim of this study is to evaluate the effectiveness of EST for cholestatic jaundice in patient with juxtapapillary diverticulum with absence of common bile duct stones.
METHODS
We recruited patients who underwent Endoscopic Retrograde Cholangio Pancreatography(ERCP) between September 2000 and May 2005. The presence of Juxtapapillary diverticula was seen in 92(29.3%)) out of 315 patients underwent ERCP. Cholestatic jaundice associated with juxtapapillary diverticula was considered when patients have jaundice, elevated serum bilirubin and alkaline phosphatase more than normal, and there are no other obstructive lesion on abdominal ultrasonography or computed tomography(CT) scan. The number of the patients were 13 who had cholestatic jaundice associated with juxtapapillary diverticula without common bile duct stones. All 13 patients underwent EST and had no complications. The patients were followed up to visit outpatient department or interviewed on the telephone.
RESULTS
Of the 13 patients, 10 were male and 3 were female. The mean age was 70.4 years and mean duration of follow-up were 28.9 months. All 13 patients who had gallbladder presented RUQ discomfort and jaundice. Seven patients presented gallstone pancreatitis with jaundice. Nine patients had GB stone, 1 patients had GB sludge. In the follow-up period, from 1month to 46 months after EST, 1 patient died of unknown cause within 1 year. One patient had recurred gall stone pancreatitis with jaundice 12 months later.
CONCLUSIONS
EST can be considered as a useful therapeutic modality especially in eldery patients with cholestatic jaundice and gallstone pancreatitis associated with juxtapapillary diverticulum.

Keyword

Obstructive jaundice; Juxtapapillary diverticula

MeSH Terms

Alkaline Phosphatase
Bilirubin
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct*
Diverticulum*
Female
Follow-Up Studies
Gallbladder
Gallstones
Humans
Jaundice
Jaundice, Obstructive*
Male
Outpatients
Pancreatitis
Sewage
Telephone
Ultrasonography
Alkaline Phosphatase
Bilirubin
Sewage