CHOLEDOCHOCELE, AN OVERLOOKED DIAGNOSIS - REPORT OF 15 CASES AND REVIEW OF 56 PUBLISHED REPORTS FROM 1984 TO 1992

Backround and Study Aims: Choledochocele (CDCL) is still regarded as b eing a rare abnormality, despite the increasing number of case reports published in the last ten years, The aim of this prospective study wa s to investigate the prevalence rate of CDCL in patients referred for endoscopic retrograde cholangiopancreatography (ERCP), as well as the short-term and long-term complications of endoscopic treatment. Patien ts and Methods: Over a seven-year period, fifteen symptomatic patients (ten male, five female, age range 47-93 years) were identified as hav ing CDCL out of a total of 1019 ERCP referrals to our unit, The diagno sis of CDCL was made by both duodenoscopy and ERCP. Results: Ah 15 pat ients had small (4-25 mm) CDCLs associated with pancreatic (n = 1) or biliary (n = 14) disorders. Ten of the 15 patients (67%) had choledoch olithiasis as well, Twelve patients were treated by endoscopic sphinct erotomy (ES), and three by surgery. The immediate post-ES complication s (2 of 12, 16.7%) were acute cholangitis (n = 1) and acute pancreatit is (n = 1), Eleven (76%) of the 14 patients who had a complete follow- up were symptom-free, with normal liver function tests at a median of 18 months (range 12-97). Two patients reported episodes of acute chola ngitis, and one patient died of a misdiagnosed ampullary carcinoma ari sing in the CDCL. Conclusions: These results suggest that CDCL is prob ably an overlooked diagnosis in patients with pancreaticobiliary sympt oms, It should be readily recognized and treated, preferably by endosc opic sphincterotomy, The endoscopist must be aware that an ampullary c arcinoma may develop in a CDCL.