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Article Outline
We thank Dr Matsushita et al for their kind comments and interest in our article.
In studies comparing cannulation success and complications between patients with and without periampullary diverticula, patients with undetectable papilla were excluded,1, 2, 3, 4 and our study is the only one in which the incidence of undetectable papilla in patients with duodenal diverticula is mentioned. It is also clearly defined that in patients with periampullary diverticula, the cannulation rate is similar and the procedure easier, compared with patients without diverticula, provided that the papilla can be found.
As regards the intradiverticular papilla, we agree that it is an indicator of difficult cannulation, but in our study, the difference in successful cannulation, between patients with extradiverticular (type I) or intradiverticular papilla (type II) was marginal (96% vs 84.8%, P = .059). Such lack of significance could be because the retrieved information on the position of the papilla was limited to two thirds of the patients. Therefore, we believe that there may be a trend toward less successful cannulation in patients with type II periampullary diverticula.
References
- Periampullary diverticula and pancreaticobiliary disease. Br J Surg. 1999;86:588–597
- The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients. Gastrointest Endosc. 2001;54:56–61
- . Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Endoscopy. 2004;36:1050–1053
- Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918
PII: S0016-5107(09)00522-7
doi:10.1016/j.gie.2009.03.034
© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Periampullary diverticulum: an indicator of easy or difficult cannulation?
