Available online 24 February 2024

Author links open overlay panel, , , , , , , AbstractBackground and study aims

Periampullary diverticula (PAD), a location-specific type of duodenal diverticula, can cause serious complications. PAD is difficult to differentially diagnose, mainly due to its nonspecific symptoms. This study aimed to identify sonographic features of PAD and to evaluate their value in the differential diagnosis of PAD from stones in the lower common bile duct (CBD).

Patients and Methods

A total of 30 patients with PAD and 60 patients with lower CBD stones were retrospectively enrolled, and sonographic features were analyzed. Measurements of sonographic features included echo shaped, posterior echo changes, location and relation to surrounding organs, and status of intrahepatic and extrahepatic bile duct dilation, and their diagnostic performance was assessed.

Results

Characteristic sonographic features of PAD were identified, including strong echoes (28/30, 93.3 %), strip shape (28/30, 93.3 %), multiple reflections in the posterior echo (27/30, 90.0 %), and location outside the CBD or near the biliary wall in connection with the duodenum (27/30, 90.0 %). Inter-observer agreement was good (Kappa values = 0.69–0.82). Comparative analysis of sonographic features revealed significant differences in echo shape, posterior echo changes (multiple reflections and acoustic shadowing), location and relation to surrounding organs, and intrahepatic and extrahepatic bile duct dilatation status between the dilatation status of the two groups. In particular, these characteristics achieved a sensitivity of 100 % and a specificity of 98 % for the differential diagnosis of PAD and lower CBD stones.

Conclusions

This study identified characteristic sonographic features of PAD, which could be used as potential diagnostic indicators to distinguish PAD from lower CBD stones.

Section snippetsBackground

Periampullary diverticula (PAD) is a specific type of duodenal diverticula located within a radius of 2–3 cm from Papilla the Vater (major papilla) in the descending portion of the duodenum [1], [2], [3], [4]. PAD represents an acquired lesion that occurs more commonly in the elderly population. The incidence of PAD increases with age, and the condition accounts for as high as 27 % of duodenal diverticula cases. Although PAD is asymptomatic in some patients, other patients with PAD develop

Inclusion and exclusion criteria for patient enrollment

In this retrospective study, patients with PAD or stones in the lower part of CBD treated in our hospital during the period between May 2012 and August 2020 were screened for eligibility. The following inclusion criteria were used to enrollment of patients in the PAD group: (1) suspected PAD on an abdominal ultrasound; (2) complete abdominal ultrasound images; and (3) PAD diagnosed and confirmed by CT/MRI, gastroscopy, or histological examination after surgery. The inclusion criteria for the

Observer consistency evaluation

Inter-observer agreement was assessed for four qualitative features, including echo intensity, echo shape, preservation of posterior echo, mesenteric location and relation to surrounding organs. The inter-observer agreement was excellent for echo intensity (κ = 0.82), echo shapes (κ = 0.82), and preservation of the posterior echo (κ = 0.76) and good for mesenteric location and relation to surrounding organs (κ = 0.69).

Comparative analysis of demographic and clinical characteristics between the PAD and lower CBD stone groups

A total of 30 patients with PAD and 60 patients with stones in the lower part

Discussion

This study produced the following key novel findings: (1) the characteristic ultrasonographic features included strong echoes (28/30, 93.3 %), a strip echo shape (28/30, 93.3 %), multiple reflections in the posterior echo (27/30, 90.0 %) and location outside the CBD or near biliary wall in connection with the duodenum (27/30, 90.0 %); (2) significant differences in the echo intensity, echo shape, posterior echo changes (multiple reflections and acoustic shadowing), location and relation to

Author contributions

All authors have made substantial contributions to this study. Conceptual design and writing of the draft manuscript: Lili Wu, Rongqin Zheng. Acquisition of data: Jinxiu Ju, Tating Su. Analysis and interpretation of data: Jiayi Liang, Xiaodan Zhang. Critical revision of the manuscript: Jie Ren. Jinxiu Ju and Tating Su contributed equally to the work.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We would like to express our sincere gratitude to Dr. Jiaxin Chen and Zhongzhen Su (Department of Medical Ultrasonics, the Fifth Affiliated Hospital of Sun Yat-Sen University), who offered their support and help with the study design and statistical analysis.

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© 2024 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.