Periampullary diverticula cause pancreatobiliary reflux

Background: Periampullary diverticula are associated with dysfunction of th e sphincter of Oddi. Papillary dysfunction may allow reflux of pancreatic j uice as well as intestinal contents into the common bile duct. We prospecti vely investigated pancreatobiliary reflux in patients with and without peri ampullary diverticula. Methods: The ductal bile was sampled for amylase con centration during endoscopic retrograde cholangiopancreatography in 47 pati ents with choledocholithiasis (n = 29; with (n = 14) or without (n = 15) pe riampullary diverticula) or gallbladder cholesterol polyps (n = 18; with (n = 6) or without (n = 12) diverticula). Results: The amylase concentration within the ductal bile was significantly higher in choledocholithiasis pati ents with periampullary diverticula (1621 +/- 587 IU/l) than in those witho ut diverticula (1155 +/- 418 IU/l). The amylase concentration tended to be higher in gallbladder polyp patients with diverticula (1087 +/- 275 IU/l) t han in those without diverticula (833 +/- 272 IU/l). Irrespective of the pr esence or absence of diverticula, patients with bile duct stones had signif icantly higher amylase concentrations than those with gallbladder polyps. C onclusions: Periampullary diverticula cause pancreatobiliary reflux. Furthe r investigation is required to determine the clinical implication of pancre atobiliary reflux.