In patients with symptomatic duodenal diverticula (DD) who also present with bile duct stones, gallstones, or cholangitis, the biliary complication profile significantly influences the treatment path — distinguishing this group from those managed conservatively.
This protocol applies when symptomatic duodenal diverticula occur together with bile duct stones and gallstones, primary bile duct stones, or cholangitis in the absence of bile duct stones. Evidence indicates that this biliary involvement is associated with a preference for surgical or endoscopic intervention rather than conservative management.
Management centres on surgical treatment directed at the duodenal diverticula themselves, with the procedure selected based on anatomical findings and the nature of the biliary complications. Depending on the type and severity of complications, additional interventional options addressing biliary pathology may also be part of the plan — the complete algorithm is in the full protocol.
DOI: 10.3389/fsurg.2023.1267436
Further, we performed a multivariate Logistics regression analysis and the results showed that patients with combined smaller-sized DD may prefer conservative treatment, while patients with combined biliary system stones and cholangitis without bile duct stones may prefer surgical treatment (direct or indirect).
The results suggest that the combination of bile duct stones and gallstones, primary bile duct stones, and cholangitis without bile duct stones may be the reason for preferring surgical treatment as well as endoscopic treatment compared to conservative treatment, while DD sizes <1 cm or 1–3 cm are the possible reason for preferring conservative treatment.
The main surgical treatment modalities for patients with DD in previous studies include diverticulectomy, duodenal resection, and diverticular inversion, and surgical treatment for DD is considered safe.
In our study, DD patients were operated on more frequently with choledochojejunostomy (43.8%) and gastrojejunostomy (20.3%), next by diverticulectomy (14.1%).
Depending on the type and severity of the complications, endoscopic treatment and cholecystectomy may be options for complications only, in addition to surgical treatments that directly target DD.
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