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JUXTAPAPILLARY DIVERTICULA AND ENDOSCOPIC TREATMENT OF BILE DUCT STONES
Authors:Jun Horaguchi  Naotaka Fujita  Yutaka Noda  Go Kobayashi  Katsumi Kimura  Kei Ito  Osamu Takasawa
Abstract:Aim: To assess the influence of juxtapapillary diverticula on endoscopic treatment of bile duct stones. Methods: Two hundred and fifty‐eight consecutive patients with bile duct stones who had undergone endoscopic treatment at our department were included in this study. Comparison was done between a group that had a juxtapapillary diverticulum (Group D) and a group that did not (Group N). Results: Deep cannulation was achieved in 98% and 100% of Group D and Group N, respectively. The time required for cannulation was 18 min in both groups. Deep cannulation of the bile duct tended to be difficult in cases with the papilla located at the edge of or in the diverticulum in Group D. Complete removal of stones was achieved in 97.7% and 96.9% of the respective groups. The number of sessions and the total time required for removal of stones in Group D and Group N were 1.6 and 47 min, and 1.5 and 47 min, respectively (n.s.). The occurrence rate of complications was not statistically different (12.4%vs 10.1%); however, it was higher (50%) in those who had a papilla inside the diverticulum. Conclusions: Although the presence of juxtapapillary diverticula has only a subtle influence on endoscopic treatment of bile duct stones, caution is necessary when treating patients with a papilla in a diverticulum because of the high incidence of complications in such patients.
Keywords:bile duct stones  endoscopic papillary balloon dilatation (EPBD)  endoscopic retrograde cholangiopancreatography (ERCP)  endoscopic sphincterotomy (EST)  juxtapapillary diverticula
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