PREVALENCE OF PERIAMPULLARY DIVERTICULUM AND ITS ASSOCIATION WITH PANCREATOBILIARY DISEASE IN PATIENTS WHO UNDERGO ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAM (ERCP): A SINGLE CENTER EXPERIENCE IN SRI LANKA

Background Periampullary diverticulum is an outpouching of the duodenum arising within the radius of 2–3 cm from the ampulla of Vater. It is usually asymptomatic and discovered incidentally during ERCP. The prevalence of this finding widely varies from 1% to 32.8% and its association with pathological conditions has been recognized in various studies. The aim of this study was to evaluate the prevalence of periampullary diverticulum and its association with pancreatobiliary diseases in the studied population. Methods The study group of 2350 patients who underwent ERCP between 2014 and 2018 at the gastroenterology unit of the National Hospital of Sri Lanka was analyzed. The prevalence of patients with periampullary diverticulum was calculated. The demographic features and its association with pancreatobiliary diseases were analyzed in patients with periampullary diverticulum. Results 132 patients with periampullary diverticulum with a mean age of 62 (range 25–89) were identified. Out of 132 patients, 72% were males. The prevalence rate of periampullary diverticulum was 5.6% in the studied population. Successful biliary or pancreatic cannulation was achieved in 97% of patients with periampullary diverticulum. The presence of choledocholithiasis was diagnosed in 73 (55.3%) patients. 13 (9.8%) patients had benign common bile duct stricture and cholangiocarcinoma was found in 11 (8.3%) patients. In addition, a small number of patients had chronic calcified pancreatitis (6, 4.5%) choledochal cyst (4, 3%) pancreatic carcinoma (4, 3%) and ampullary neoplasm (3, 2.3%). However, 14 (10.6%) patients had no structural lesion as a cause for biliary obstruction. Conclusions The prevalence of periampullary diverticulum in our study population is lower than most previous reports. The presence of periampullary diverticulum is found more commonly in the elderly population with male preponderance. A significant association between choledocholithiasis and periampullary diverticulum is observed in this study