Influence of juxtapapillary diverticulum on hepatic clearance in patients after endoscopic sphincterotomy


Dr Kwok-Hung Lai, Department of Internal Medicine, Kaohsiung Veterans General Hospital, 386 Ta Chung 1st Road, Kaohsiung, 813, Taiwan. Email:


Background and Aim:  The role of juxtapapillary diverticulum ( JPD) in biliary stone formation is controversial. This study was designed to understand the relationship between the size of JPD, hepatic clearance and recurrent bile duct stones in patients after endoscopic sphincterotomy.

Methods:  Five hundred and twenty patients with choledocholithiasis who had received endoscopic sphincterotomy were enrolled. They were divided into three groups: group A (n = 268) without diverticula; group B (n = 156) with small diverticula; and group C (n = 96) with large diverticula. All patients were regularly followed with interviews, liver function test and sonogram to detect the recurrent bile duct stones. Quantitative cholescintigraphy was performed in 176 cholecystectomized patients to evaluate the hepatic clearance. Sphincter of Oddi manometry was performed to exclude incomplete sphincterotomy if quantitative cholescintigraphy was abnormal.

Results:  After 9–111 months of follow-up, 76 patients had recurrent bile duct stones. There was a significant higher bile duct stone recurrence in group C than in group A (< 0.01), but no statistical difference was noted between group B and group A (= 0.2). Patients with JPD were older than those without (< 0.05). Of 176 cholecystectomized patients, two were excluded because sphincter of Oddi basal pressure was more than 10 mmHg. In the remaining 174 patients, the E45′ was significantly lower in group C than in group A (41.2% ± 18.6%vs 49.1% ± 14.1%; P < 0.05), and there was no significant difference between group B and group A.

Conclusions:  JPD is a predisposing factor of delayed biliary emptying and it increases the chance and incidence of recurrent bile duct stones.