Diagnosis And Treatment Of Juxta-ampullary Duodenal Diverticulum

Objective: To summarize the diagnosis and treatment of juxta-ampullary duodenal diverticulum (JAD) in our clinical practice.Method: Of 5000 consecutive endoscopic retrograde cholangiopancreatography (ERCP) cases had been performed in our hospital and other hospitals, 225 patients were diagnosed with JAD and treated with all kinds of therapy. All those patients were classified into two groups based on the anatomic location of Ampullae of Vater in relation to the duodenal diverticulum. In all of these 225 JAD cases, 96 patients (42.6%) required surgery.Results: The 225 patients with JAD were divided into Type A (146 cases, 64.9%) or Type B (79 cases, 35.1%). Type A patients presented with the papillae near the diverticulum or in its margin. In this type, 36 patients (24.7%) presented with perforation, bleeding,paradiverticular abscess or cholelithiasis, and were treated surgically. Type B patients presented with the papillae opening inside the diverticulum itself. Among these cases, 60 patients (75.9%) had severe complications and required surgical intervention. Conclusions: JAD could be divided into two types based on anatomic location of the papillae and the diverticulum. ERCP could be used as the primary method of diagnosing of JAD and those patients with severe complications required surgical intervention.