Endoscopic therapeutics for patients with cholangitis caused by the juxtapapillary duodenal diverticulum

The role of endoscopic intervention for cholangitis caused by the juxtapapillary duodenal diverticulum without choledocholithiasis, i.e., the Lemmel's syndrome remains controversial. The aims of the study were to characterize these patients and evaluate endoscopic therapy for Lemmel's syndrome.

This study retrospectively reviewed 1923 endoscopic retrograde cholangiopancreatograms of patients with cholangitis during a three-year period, and 337 of these patients with juxtapapillary duodenal diverticula were included. Two groups (i.e., one with and one without Lemmel's syndrome) were compared.

Lemmel's syndrome was diagnosed in 39 patients (39/337, 11.6%). Both groups had similar cannulation success rates (94.9% vs. 87.9%, p = 0.28) and complication rates (2.6% vs. 8%, p = 0.33). Patients with Lemmel's syndrome were significantly older (mean 74.5 years vs. 66.6 years, p < 0.001) and had significantly larger diverticula (mean 3.9cm vs. 1.9cm, p < 0.001). Of these 39 patients, 15 received endoscopic sphincterotomy (38.5%), 3 received stenting (7.7%), 6 had impacted bezoars (15.4%), 2 underwent surgery due to failed cannulation (5.1%), 19 (48.7%) received conservative treatment after diagnostic cholangiography, and 1 had significant bleeding (2.6%).

Patients with Lemmel's syndrome are older and have larger juxtapapillary duodenal diverticula. Endoscopic cannulation is not hampered by this anatomical difference and is not associated with higher complication rate.