IS THE DIVERTICULAR PAPILLA A FACTOR IN THE FAILURE OF CATHETERIZATION OF THE MAIN BILE DUCT IN LITHIASIS PATHOLOGY? EXPERIENCE OF A MOROCCAN DEPARTMENT

Aims The duodenal diverticula are frequent (6 to 20%), and they preferentially sit in the papillary region and are called juxta-, peri-para-papillary or valerian. The latter may be a difficulty in the catheterization of the main bile duct and are more common in cases of associated cholelithiasis.

The objective of our study is to calculate the prevalence of juxta-papillary diverticula (JPD) in patients with VBP lithiasis and evaluate their influence on the success rate of main bile duct catheterization in lithiasis pathology.

Methods This is a retrospective study conducted from April 2004 until April 2019. There were included 846 patients having benefited from an ERCP for lithiasis of the main bile duct. The presence or absence of a juxta-papillary diverticulum has been noted. We compared the success rate of catheterization of the main bile duct in patients with juxta-papillary diverticulum (group I) versus patients without diverticular disc (group II).

Results The mean age of the patients was 58 ± 13 years, 515 women and 331 men (sex ratio H/F: 0.64). Patients with a diverticular disc (group I) accounted for 9.6% of the patients included (81 patients). Group II consisted of 765 patients (90.4%). The success rate of the main bile duct catheterization was 96.4% in group II versus 86.5% in group I (p: 0.007). The overall rate of early complications was 6% in group II versus 7.4% in group I (p = 0.12).

Conclusions The presence of a PDI appears to significantly decrease the success rate of the main bile duct catheterization in lithiasis pathology without increasing the risk of early complications. Prospective studies with large series, however, remain necessary to confirm these results.