Treatment of Symptomatic Duodenal Diverticula with Small Diverticular Size (<1 cm or 1–3 cm) Without Bile Duct Stones or Cholangitis

Not all symptomatic duodenal diverticula (DD) are managed the same way. Diverticular size and the presence or absence of biliary complications are key factors that determine which treatment approach is appropriate.

Clinical scenario This protocol applies to patients with symptomatic duodenal diverticula characterised by a diverticular size of <1 cm or 1–3 cm, in the absence of bile duct stones, gallstones, primary bile duct stones, and cholangitis without bile duct stones. Evidence shows that smaller diverticular size, without concurrent biliary pathology, is associated with a distinct management preference compared to cases complicated by biliary stones or cholangitis.

Treatment approach (partial overview) For this sub-population, the evidence supports a conservative treatment strategy. The complete structured protocol — including specific criteria, management steps, and decision thresholds — is available in full below.

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References

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.

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