Abstract: This study investigated endoscopic retrograde cholangiopancreatography (ERCP)-guided small endoscopic sphincterotomy (sEST) plus balloon dilatation in the treatment of juxtapapillary duodenal diverticulum (JPDD) complicated with choledocholithiasis. A total of 94 patients with JPDD complicated with choledocholithiasis were selected and divided into elderly group of 47 cases (60-85 years old) and non-elderly group of 47 cases (35-59 years old). Both of the group patients were treated with sEST+balloon dilation under the guidance of ERCP, and counted the gastrointestinal function, complications, liver function before and after surgery [direct bilirubin (DBIL), total bilirubin (TBIL), alanine aminotransferase (ALT)], stress response [adrenocorticotropic hormone (ACTH), corticosteroids (COR), adrenaline (A), norepinephrine (NE)] and inflammatory indicators [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] levels. The results showed that there was no significant difference in the completion of the operation, the recovery of gastrointestinal function, and the incidence of complications between the two groups. The postoperative liver function indexes were significantly decreased (P<0.05), while there was no significant difference between the two groups (P>0.05). After one and three days of operation, the levels of serum stress response and inflammatory indexes in the two groups were higher than those before operation, and the elderly group was significantly higher than the non-elderly group after one-day operation (P<0.05). The results showed that sEST+balloon dilation under the guidance of ERCP was safe and effective in the treatment of JPDD complicated with choledocholithiasis, but the elderly patients could have stronger stress and inflammatory reactions.

Key words: endoscopic retrograde cholangiopancreatography, small incision of the nipple sphincter, balloon dilation, juxtapapillary duodenal diverticulum, choledocholithiasis