Periampullary diverticula and pancreaticobiliary disease

Background: Periampullary diverticula (PAD) are extraluminal outpouchings o f the duodenum arising within a radius of 2-3 cm from the ampulla of Vater. They are frequently encountered in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and contribute to failure of ERC P. This review details the relationship of PAD to pancreaticobiliary diseas e and the influence of PAD on the management of patients. Methods: The United States National Library of Medicine Medline database wa s searched for articles on and related to PAD published in English within t he past 15 years. Major earlier works were also reviewed. Results: The prevalence of PAD increases with age and could be as high as 2 7 per cent. PAD are associated with an incompetent sphincter of Oddi and co lonization of bile duct with beta-glucuronidase-producing organisms. PAD ar e implicated in the pathogenesis of pigment. common bile duct stones, but t here is no conclusive evidence to associate them with cholecystolithiasis o r pancreatitis. PAD are a major cause of failure of ERCP, but success rates of more than 90 per cent have been achieved in specialist centres. Conclusion: With an ageing population, there will be an increase in elderly patients with PAD and symptomatic pancreaticobiliary disease. Continuing i mprovements in radiological and endoscopic techniques should enable this vu lnerable group to be treated effectively and safely.