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[Endoscopic papillosphincterotomy in patients with para-ampullar diverticulosis].

It is suggested that the numerous variants of diverticula occurring in the region of the major duodenal papilla should be grouped into four types. Type I--the major duodenal papilla (MDP) is on the floor of the diverticulum; type II--the MDP is in the region of the lower ++semi-circumference of the diverticular orifice while the longitudinal fold runs radially on the wall of the diverticulum; type III--the MDP is in the region of the orifice of the diverticulum while the longitudinal fold does not pass on its wall; type IV--two diverticula located above the MDP to both sides of the longitudinal fold. Endoscopic papillosphincterotomy is considered contraindicated in patients with type I diverticulum. When indicated, the intervention was carried out in patients with types III and IV diverticula. Endoscopic papillosphincterotomy can be conducted in patients with type II diverticulum measuring more than 2 cm.

Adult↗

[Diverticulosis of the distal end of the choledochus demonstrated by retrograde endoscopic cholangiopancreatography. Apropos of 5 case reports].

We report on 5 observations (3 females, 2 males, mean age 66 years) of diverticula located on the left side of the distal end of the choledochus, demonstrated by ERCP. No specific symptom due to the diverticula could be found. The pathogenesis of the diverticula of the choledochus is unclear: congenital lesion for most authors, or acquired lesion secondary to reflux of pancreatic juice for others. We propose a hypothesis based on data from manometry of the sphincter of Oddi. The diverticula located above the sphincter of Oddi on a passive segment of the biliary tree could be congenital whereas the diverticula of the high pressure zone (just above the papillary orifice) might be acquired.

Aged↗

[Tiropramide hydrochloride in the premedication of diagnostic and therapeutic proctosigmoidocolonoscopy (endoscopic polypectomy) and the treatment of colonic diverticulosis].

This study was undertaken with a view to assessing the effectiveness and tolerance of tiropramide hydrochloride in the premedication of endoscopic rectosigmoidoscopy. The following were considered for this purpose: 1) speed of execution of the procedure; 2) its tolerance; 3) possible complications. The effectiveness of tiropramide was also examined in uncomplicated diverticular disease: 1) comparison of execution times for rectosigmoidoscopy before and after therapy; 2) the evaluation of the reduction in symptomatology. The patients were subdivided into three groups: 1st group submitted to diagnostic rectosigmoidoscopy; 2nd group submitted to therapeutic rectosigmoidoscopy; 3rd group with diverticular disease. In the first group, execution times were less than 20 minutes in all cases bar 1 and tolerance was good in 27 cases, average in 3. In the second group, times were less than 15 minutes in 6 cases and higher in 4, and tolerance was good in 7 cases and average in 3. In the third group (10 patients), examination execution time was reduced after therapy in 9 cases and in the same number pain symptomatology regressed. Tiropramide proved to be the antispastic of choice in premedication for rectosigmoidoscopy and an effective drug in the treatment of uncomplicated diverticular disease.

Adult↗