Korean Journal of Gastrointestinal Endoscopy 2001;22(4): 239-244.
Two Cases of Extended Endoscopic Sphincterotomy in Patients with Periampullary Diverticulum ―How do we estimate the upper margin of intramural ampulla in patients with periampullary diverticulum?―
Sang Heum Park, M.D., In Ho Kim, M.D., Eun Joo Kim, M.D.,Il Kwun Chung, M.D., Hong Soo Kim, M.D., Moon Ho Lee, M.D. and Sun Joo Kim, M.D.
Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Choan Hospital, Chunan, Korea
Abstract
Periampullary diverticulum (PAD), which was frequently noticed during endocopic retrograde cholangiopancreatography (ERCP) for examination on patients with pancreaticobiliary diseases, made difficult to cannulate the duct and to perform the endoscopic sphincterotomy (EST). EST was very useful therapeutic modality for pancreaticobiliary disease, but endoscopists are always careful about EST-related complication, especially in patients with PAD. The general principle of EST was not to incise extendedly above the papillary roof, but the following endoscopic findings help to try the extended EST safely above the papillary roof. On the endoscopic examination there was reducible protrusion above papilla by contrast injection or air deflation, which had bile-colored transparency and arborescent capillary network in the usual direction of the bile duct. We have recently experienced 2 cases of extended EST in patients with PAD, who showed the endoscopic findings mentioned above and recovered without bleeding or perforation. (Korean J Gastrointest Endosc 2001;22:239244)
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